Provider Demographics
NPI:1861483208
Name:ECKSTEIN-VANGELDER, AMY (PA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ECKSTEIN-VANGELDER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORPORATE DR
Mailing Address - Street 2:STRATEGIC SOLUTIONS MANAGEMENT CONSULTANTS
Mailing Address - City:HALFMOON
Mailing Address - State:NY
Mailing Address - Zip Code:12065-8635
Mailing Address - Country:US
Mailing Address - Phone:518-348-1276
Mailing Address - Fax:518-383-8104
Practice Address - Street 1:3050 ROUTE 50
Practice Address - Street 2:SARATOGA HOSPITAL - SARATOGA CENTER FOR ENDOCRINOLOGY
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2958
Practice Address - Country:US
Practice Address - Phone:518-348-1276
Practice Address - Fax:518-383-8104
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02347717Medicaid
NYP00304555OtherRR MEDICARE
S87249Medicare UPIN
NY02347717Medicaid