Basic Information
Provider Information | |||||||||
NPI: | 1255334850 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | OKEEFFE | ||||||||
FirstName: | JAMES | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 45 HUDSON AVE | ||||||||
Address2: | PO BOX 144 | ||||||||
City: | GLENS FALLS | ||||||||
State: | NY | ||||||||
PostalCode: | 128014313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5187934477 | ||||||||
FaxNumber: | 5187987541 | ||||||||
Practice Location | |||||||||
Address1: | 45 HUDSON AVE | ||||||||
Address2: |   | ||||||||
City: | GLENS FALLS | ||||||||
State: | NY | ||||||||
PostalCode: | 128014313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5187934477 | ||||||||
FaxNumber: | 5187987541 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/27/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 126053 | NY | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
ID | Type | State | Issuer | Description | 160012994 | 01 | NY | RAILROAD MEDICARE | OTHER | 000416210002 | 01 | NY | BLUE SHIELD | OTHER | 040426007603 | 01 | NY | FIDELIS | OTHER | 15145 | 01 | NY | MVP | OTHER | 348851 | 01 | NY | BLUE CROSS | OTHER | 10002779 | 01 | NY | CDPHP | OTHER | 00369104 | 05 | NY |   | MEDICAID |