Provider Demographics
NPI:1740266188
Name:DAILEY, MICHAEL E (MY)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:DAILEY
Suffix:
Gender:M
Credentials:MY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1407
Mailing Address - Country:US
Mailing Address - Phone:518-701-2000
Mailing Address - Fax:518-701-2020
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:STE 205
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5012
Practice Address - Country:US
Practice Address - Phone:518-482-9111
Practice Address - Fax:518-482-6142
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201074174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY128609OtherWELLCARE
NY01604535Medicaid
NY3519210OtherBLUE CROSS
NY362374OtherMVP
NY10000434OtherCDPHP
NY5350585OtherAETNA
NY28609OtherGHI HMO
NY000406966004OtherBLUE SHIELD
NY0600376OtherGHI
NY33680IMedicare ID - Type Unspecified
NY000406966004OtherBLUE SHIELD
NY28609OtherGHI HMO