Basic Information
Provider Information | |||||||||
NPI: | 1790869634 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RECTOR | ||||||||
FirstName: | DONNA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | SGARLATA | ||||||||
OtherFirstName: | DONNA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | NP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 711 TROY SCHENECTADY RD | ||||||||
Address2: | SUITE 201 | ||||||||
City: | LATHAM | ||||||||
State: | NY | ||||||||
PostalCode: | 121102442 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5187823700 | ||||||||
FaxNumber: | 5187823799 | ||||||||
Practice Location | |||||||||
Address1: | 2125 RIVER RD STE 103 | ||||||||
Address2: |   | ||||||||
City: | SCHENECTADY | ||||||||
State: | NY | ||||||||
PostalCode: | 123091135 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5183819355 | ||||||||
FaxNumber: | 5183819216 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/25/2006 | ||||||||
LastUpdateDate: | 10/07/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/07/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F331636 | NY | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 02347455 | 05 | NY |   | MEDICAID |