Basic Information
| Provider Information | |||||||||
| NPI: | 1255795696 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARATOGA HOSPITAL | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | SARATOGA FAMILY PHYSICANS, RTE 50 | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3044 ROUTE 50 | ||||||||
| Address2: | FAMILY PHYSICIANS OFFICE | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128663073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865800 | ||||||||
| FaxNumber: | 5188865805 | ||||||||
| Practice Location | |||||||||
| Address1: | 3044 ROUTE 50 | ||||||||
| Address2: | FAMILY PHYSICIANS OFFICE | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128663073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865800 | ||||||||
| FaxNumber: | 5188865805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 04/12/2016 | ||||||||
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| AuthorizedOfficialLastName: | FOSTER | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 5188865800 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SARATOGA HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.