Provider Demographics
NPI:1245628361
Name:ST. PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:ST. PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO PHYSICIAN ENTERPRISE
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-1585
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-525-5206
Mailing Address - Fax:518-525-5209
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-525-5206
Practice Address - Fax:518-525-5209
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty