Provider Demographics
NPI:1780694059
Name:ADIRONDACK MEDICAL CENTER
Entity type:Organization
Organization Name:ADIRONDACK MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:LABA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-897-2301
Mailing Address - Street 1:114 WAWBEEK AVE
Mailing Address - Street 2:
Mailing Address - City:TUPPER LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12986-2038
Mailing Address - Country:US
Mailing Address - Phone:518-359-3355
Mailing Address - Fax:518-359-9055
Practice Address - Street 1:114 WAWBEEK AVE
Practice Address - Street 2:
Practice Address - City:TUPPER LAKE
Practice Address - State:NY
Practice Address - Zip Code:12986-2038
Practice Address - Country:US
Practice Address - Phone:518-359-3355
Practice Address - Fax:518-359-9055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA2859OtherPIN
NY00314145Medicaid
NY81032AMedicare ID - Type UnspecifiedGROUP #
NY335220Medicare ID - Type UnspecifiedMEDICARE