Provider Demographics
NPI: | 1013292002 |
---|---|
Name: | HUDSON HEADWATERS HEALTH NETWORK |
Entity Type: | Organization |
Organization Name: | HUDSON HEADWATERS HEALTH NETWORK |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE VP, CFO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PASCO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 518-761-0300 |
Mailing Address - Street 1: | 9 CAREY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | QUEENSBURY |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 12804-7880 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 518-761-0300 |
Mailing Address - Fax: | 518-824-2388 |
Practice Address - Street 1: | 161 CAREY RD |
Practice Address - Street 2: | |
Practice Address - City: | QUEENSBURY |
Practice Address - State: | NY |
Practice Address - Zip Code: | 12804-7821 |
Practice Address - Country: | US |
Practice Address - Phone: | 518-824-8610 |
Practice Address - Fax: | 518-824-2390 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | HUDSON HEADWATERS HEALTH NETWORK |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2011-10-21 |
Last Update Date: | 2024-02-23 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
103T00000X, 207PS0010X, 207Q00000X, 207R00000X, 207RE0101X, 207RN0300X, 207RR0500X, 207V00000X, 2084N0400X, 2084P0800X, 2086S0129X, 213E00000X, 261QP2300X, 363A00000X | ||
NY | 5660200R | 261QF0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
No | 207PS0010X | Allopathic & Osteopathic Physicians | Emergency Medicine | Sports Medicine | Group - Multi-Specialty |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty | |
No | 261QF0400X | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | 03470413 | Medicaid | |
NY | 331033 | Medicare Oscar/Certification | |
NY | 52975A | Medicare PIN |