Provider Demographics
NPI:1851326326
Name:IRONGATE FAMILY PRACTICE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:IRONGATE FAMILY PRACTICE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:EMBLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-793-4409
Mailing Address - Street 1:3 IRONGATE CENTER
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3471
Mailing Address - Country:US
Mailing Address - Phone:518-793-4409
Mailing Address - Fax:518-615-0140
Practice Address - Street 1:3 IRONGATE CENTER
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3471
Practice Address - Country:US
Practice Address - Phone:518-793-4409
Practice Address - Fax:518-615-0140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1290OtherCDPHP
NY080095470OtherRAILROAD MEDICARE
NY56402AMedicare PIN