Basic Information
| Provider Information | |||||||||
| NPI: | 1225359540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIERNEY | ||||||||
| FirstName: | RACHEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 41 NICKLAUS DR | ||||||||
| Address2: | |||||||||
| City: | GANSEVOORT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128311779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182817153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 WEST AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128666045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186934699 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2010 | ||||||||
| LastUpdateDate: | 08/11/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA3991 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.