Basic Information
| Provider Information | |||||||||
| NPI: | 1548518582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GLENS FALLS HOSPITAL INC | ||||||||
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| OtherOrganizationName: | WILTON FAMILY MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 304 | ||||||||
| Address2: | ADIRONDACK MEDICAL SERVICES | ||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128010304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189266999 | ||||||||
| FaxNumber: | 5189266984 | ||||||||
| Practice Location | |||||||||
| Address1: | 135 NORTH RD | ||||||||
| Address2: | WILTON FAMILY MEDICINE | ||||||||
| City: | WILTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128311308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5189261935 | ||||||||
| FaxNumber: | 5189264804 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2012 | ||||||||
| LastUpdateDate: | 10/24/2016 | ||||||||
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| AuthorizedOfficialLastName: | SCIMECA | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT PHYSICIAN PRACTICES | ||||||||
| AuthorizedOfficialTelephone: | 5189265902 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GLENS FALLS HOSPITAL INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.