ALBANY MEDICAL COLLEGE

Provider Demographics

• NPI: 1164456067
• Name: ALBANY MEDICAL COLLEGE
• Entity type: Organization
• Organization Name: ALBANY MEDICAL COLLEGE
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: DEAN
• Authorized Official - First Name: VINCENT
• Authorized Official - Middle Name: P
• Authorized Official - Last Name: VERDILE
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 518-262-3773
• Mailing Address - Street 1: 1275 BROADWAY # MC106
• Mailing Address - City: MENANDS
• Mailing Address - State: NY
• Mailing Address - Zip Code: 12204-2638
• Mailing Address - Country: US
• Mailing Address - Phone: 518-262-9705
• Mailing Address - Fax: 518-262-9767
• Practice Address - Street 1: 47 NEW SCOTLAND AVE
• Practice Address - Street 2: MC 74
• Practice Address - City: ALBANY
• Practice Address - State: NY
• Practice Address - Zip Code: 12208-3412
• Practice Address - Country: US
• Practice Address - Phone: 518-262-8886
• Practice Address - Fax: 518-262-2675
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-07-10
• Last Update Date: 2020-04-22

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207VC0200X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Critical Care Medicine	Group - Multi-Specialty
No	207VE0102X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Reproductive Endocrinology	Group - Multi-Specialty
No	207VG0400X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Gynecology	Group - Multi-Specialty
No	207VM0101X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Maternal & Fetal Medicine	Group - Multi-Specialty
No	207VX0000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Obstetrics	Group - Multi-Specialty
No	207VX0201X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology	Gynecologic Oncology	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty
No	367A00000X	Physician Assistants & Advanced Practice Nursing Providers	Advanced Practice Midwife		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NY	01520676	Medicaid
NY	01675103	Medicaid
MA	9766804	Medicaid
VT	1006966	Medicaid
NY	00762212	Medicaid
NY	01227105	Medicaid
NY	CA8671	Medicare ID - Type Unspecified	RR
NY	39068A	Medicare ID - Type Unspecified	GROUP
NY	00762212	Medicaid
NY	CB9202	Medicare ID - Type Unspecified	RR
MA	9766804	Medicaid
NY	C30640	Medicare ID - Type Unspecified	RR
NY	CJ0927	Medicare ID - Type Unspecified	RR
NY	CB9219	Medicare ID - Type Unspecified	RR
VT	1006966	Medicaid