Provider Demographics
NPI:1255772729
Name:PRIMARY CARE HEALTH PARTNERS-ADIRONDACK LLC
Entity type:Organization
Organization Name:PRIMARY CARE HEALTH PARTNERS-ADIRONDACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICIER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-872-4326
Mailing Address - Street 1:66 KNIGHT LN STE 10
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9308
Mailing Address - Country:US
Mailing Address - Phone:802-872-4327
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1874
Practice Address - Country:US
Practice Address - Phone:518-562-0151
Practice Address - Fax:518-562-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty