Basic Information
| Provider Information | |||||||||
| NPI: | 1245688621 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MEDICINE POPULATION HEALTH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 NEW KARNER RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122053882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186403260 | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 NEW KARNER RD | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122053882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186403260 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | LEMANSKI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | SITE MEDICAL MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5186403260 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CAPITALCARE MEDICAL GROUP, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.