Provider Demographics
NPI:1851341580
Name:NORTHEAST NEPHROLOGY ASSOC P C
Entity Type:Organization
Organization Name:NORTHEAST NEPHROLOGY ASSOC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-274-5660
Mailing Address - Street 1:258 HOOSICK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2444
Mailing Address - Country:US
Mailing Address - Phone:518-274-5660
Mailing Address - Fax:518-274-5666
Practice Address - Street 1:258 HOOSICK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2444
Practice Address - Country:US
Practice Address - Phone:518-274-5660
Practice Address - Fax:518-274-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31821AMedicare ID - Type Unspecified