Provider Demographics
NPI:1770741514
Name:DR STEPHEN E CARNEY DR CHRISTOPHER H REILLY DR BRET D GELDER
Entity type:Organization
Organization Name:DR STEPHEN E CARNEY DR CHRISTOPHER H REILLY DR BRET D GELDER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOELLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FALCONIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-456-6104
Mailing Address - Street 1:10 AIRLINE DRIVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-456-6104
Mailing Address - Fax:518-456-5041
Practice Address - Street 1:10 AIRLINE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1025
Practice Address - Country:US
Practice Address - Phone:518-456-6104
Practice Address - Fax:518-456-5041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4304211223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty