Basic Information
| Provider Information | |||||||||
| NPI: | 1700964210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMBERT | ||||||||
| FirstName: | JASON | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128661009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185802022 | ||||||||
| FaxNumber: | 5185840466 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 BROAD ST | ||||||||
| Address2: | |||||||||
| City: | SCHUYLERVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128711024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186953668 | ||||||||
| FaxNumber: | 5186953614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 028177 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00697301 | 05 | NY | MEDICAID |