Provider Demographics
NPI:1831204775
Name:ADIRONDACK CANCER CARE
Entity type:Organization
Organization Name:ADIRONDACK CANCER CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MORRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-761-0000
Mailing Address - Street 1:420 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2929
Mailing Address - Country:US
Mailing Address - Phone:518-761-0000
Mailing Address - Fax:518-793-2926
Practice Address - Street 1:420 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2929
Practice Address - Country:US
Practice Address - Phone:518-761-0000
Practice Address - Fax:518-793-2926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01707813Medicaid
NY1299850001Medicare NSC
NY56254AMedicare PIN