Provider Demographics
NPI:1811197718
Name:ALBANY THORACIC AND ESOPHAGEAL SURGERY, PLLC
Entity Type:Organization
Organization Name:ALBANY THORACIC AND ESOPHAGEAL SURGERY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARROCH
Authorized Official - Middle Name:WO
Authorized Official - Last Name:MOORES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-581-8739
Mailing Address - Street 1:317 S MANNING BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1738
Mailing Address - Country:US
Mailing Address - Phone:518-581-8739
Mailing Address - Fax:518-581-8742
Practice Address - Street 1:317 S MANNING BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1738
Practice Address - Country:US
Practice Address - Phone:518-581-8739
Practice Address - Fax:518-581-8742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161924-1208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty