Provider Demographics
NPI:1023240454
Name:ADIRONDACK REGISTERED PROFESSIONAL NURSING SERVICES PLLC
Entity type:Organization
Organization Name:ADIRONDACK REGISTERED PROFESSIONAL NURSING SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:POMMENVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-886-8251
Mailing Address - Street 1:100 SARATOGA VILLAGE BLVD STE 51
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3738
Mailing Address - Country:US
Mailing Address - Phone:518-886-8251
Mailing Address - Fax:518-400-1069
Practice Address - Street 1:100 SARATOGA VILLAGE BLVD STE 51
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-3738
Practice Address - Country:US
Practice Address - Phone:518-886-8251
Practice Address - Fax:518-400-1069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D2001059291U00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No291U00000XLaboratoriesClinical Medical Laboratory