Provider Demographics
NPI:1912545344
Name:OLDENDORF MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:OLDENDORF MEDICAL SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:OLDENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-435-1300
Mailing Address - Street 1:407 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1900
Mailing Address - Country:US
Mailing Address - Phone:518-435-1300
Mailing Address - Fax:518-435-1397
Practice Address - Street 1:21 EVERETT RD EXT
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3357
Practice Address - Country:US
Practice Address - Phone:518-435-1300
Practice Address - Fax:518-435-1397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLDENDORF MEDICAL SERVICES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty