Provider Demographics
NPI:1669408068
Name:SARATOGA RHEUMATOLOGY, PC
Entity type:Organization
Organization Name:SARATOGA RHEUMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:COSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-584-4953
Mailing Address - Street 1:5 MOUNTAIN LEDGE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1856
Mailing Address - Country:US
Mailing Address - Phone:518-584-4953
Mailing Address - Fax:518-584-7916
Practice Address - Street 1:5 MOUNTAIN LEDGE
Practice Address - Street 2:SUITE C
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1856
Practice Address - Country:US
Practice Address - Phone:518-584-4953
Practice Address - Fax:518-584-7916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180296207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0955Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER