Provider Demographics
NPI:1801887773
Name:SCIALABBA, FRED PATRICK (MD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:PATRICK
Last Name:SCIALABBA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-0304
Mailing Address - Country:US
Mailing Address - Phone:518-793-8160
Mailing Address - Fax:518-793-8709
Practice Address - Street 1:454 GLEN ST
Practice Address - Street 2:GFH NEUROSURGERY & SPINE
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2974
Practice Address - Country:US
Practice Address - Phone:518-793-8160
Practice Address - Fax:518-793-8709
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY140140207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01061701Medicaid
NYP00894388OtherRR MEDICARE
NYJ400011210Medicare PIN
NYP00894388OtherRR MEDICARE