Provider Demographics
NPI:1003858580
Name:ADIRONDACK SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:ADIRONDACK SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSIGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-761-2347
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0787
Mailing Address - Country:US
Mailing Address - Phone:518-761-2347
Mailing Address - Fax:518-793-6658
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4449
Practice Address - Country:US
Practice Address - Phone:518-761-2347
Practice Address - Fax:518-793-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB76922Medicare UPIN
30125AMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER