Provider Demographics
NPI:1356357172
Name:SARATOGA PET ASSOCIATES LLC
Entity type:Organization
Organization Name:SARATOGA PET ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCCANDLESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-235-0827
Mailing Address - Street 1:130 CANVASS ST
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-3049
Mailing Address - Country:US
Mailing Address - Phone:518-235-0827
Mailing Address - Fax:518-237-3106
Practice Address - Street 1:3 EMMA LN
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3763
Practice Address - Country:US
Practice Address - Phone:518-373-8270
Practice Address - Fax:518-373-8235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0420Medicare ID - Type Unspecified