Provider Demographics
NPI:1740673979
Name:ENDOCRINOLOGY TROY
Entity type:Organization
Organization Name:ENDOCRINOLOGY TROY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELLANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-452-1337
Mailing Address - Street 1:1304 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1403
Mailing Address - Country:US
Mailing Address - Phone:518-273-3755
Mailing Address - Fax:518-273-6865
Practice Address - Street 1:1304 PARK BLVD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1403
Practice Address - Country:US
Practice Address - Phone:518-273-3755
Practice Address - Fax:518-273-6865
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITALCARE MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty