Provider Demographics
NPI:1952411126
Name:ALBANY GASTROENTEROLOGY CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:ALBANY GASTROENTEROLOGY CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:NOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-438-4483
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1056
Mailing Address - Country:US
Mailing Address - Phone:518-438-4483
Mailing Address - Fax:518-482-4201
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1056
Practice Address - Country:US
Practice Address - Phone:518-438-4483
Practice Address - Fax:518-482-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01664135Medicaid
NY01664135Medicaid