Basic Information
| Provider Information | |||||||||
| NPI: | 1881924322 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SARATOGA HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SARATOGA FAMILY PHYSICIANS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 412655 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022412655 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3044 ROUTE 50 | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128662906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188865800 | ||||||||
| FaxNumber: | 5188865805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2010 | ||||||||
| LastUpdateDate: | 04/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | STAHURA | ||||||||
| AuthorizedOfficialFirstName: | KATHLEEN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5185838346 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SARATOGA HOSPITAL | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 251J00000X | N | Agencies | Nursing Care | 261QA1903X | N | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QP1100X | N | Ambulatory Health Care Facilities | Clinic/Center | Podiatric | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 261QS0132X | N | Ambulatory Health Care Facilities | Clinic/Center | Ophthalmologic Surgery | 261QS1200X | N | Ambulatory Health Care Facilities | Clinic/Center | Sleep Disorder Diagnostic | 273R00000X | N | Hospital Units | Psychiatric Unit | 282N00000X | N | Hospitals | General Acute Care Hospital | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.