Provider Demographics
NPI:1790796035
Name:COMMUNITY CARE PHYSICIANS, PLLC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHYSICIANS, PLLC
Other - Org Name:TROY FAMILY PHYSICIANS OF COMMUNITY CARE PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:COONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-213-0478
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:200 NORTHERN DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1821
Practice Address - Country:US
Practice Address - Phone:518-237-7363
Practice Address - Fax:518-237-8995
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY CARE PHYSICIANS, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty