Provider Demographics
NPI:1780618603
Name:CAPITAL DISTRICT COLON & RECTAL SURGERY ASSOC., P.C.
Entity type:Organization
Organization Name:CAPITAL DISTRICT COLON & RECTAL SURGERY ASSOC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORA
Authorized Official - Middle Name:
Authorized Official - Last Name:YIP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-438-2776
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-438-2776
Mailing Address - Fax:
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-438-2776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33642AMedicare PIN