Basic Information
Provider Information
NPI: 1245595396
EntityType: 2
ReplacementNPI:  
OrganizationName: SARATOGA HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: SARATOGA HOSPITAL SURGERY GROUP
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1368
Address2:  
City: ALBANY
State: NY
PostalCode: 122011368
CountryCode: US
TelephoneNumber: 5183481276
FaxNumber: 5183481279
Practice Location
Address1: 1 WEST AVE
Address2: SUITE 125
City: SARATOGA SPRINGS
State: NY
PostalCode: 128666045
CountryCode: US
TelephoneNumber: 5186934418
FaxNumber: 5186934481
Other Information
ProviderEnumerationDate: 07/05/2012
LastUpdateDate: 01/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: FOSTER
AuthorizedOfficialFirstName: GARY
AuthorizedOfficialMiddleName: L
AuthorizedOfficialTitleorPosition: VP AND CFO
AuthorizedOfficialTelephone: 5185838421
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: SARATOGA HOSPITAL
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
282N00000X  N HospitalsGeneral Acute Care Hospital 
208600000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

No ID Information.


Home