Basic Information
Provider Information | |||||||||
NPI: | 1972737427 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ENGEL | ||||||||
FirstName: | GERALD | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | B.S. PHARMACY | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1 CATHYWOOD CT | ||||||||
Address2: |   | ||||||||
City: | CLIFTON PARK | ||||||||
State: | NY | ||||||||
PostalCode: | 120658728 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5183834004 | ||||||||
FaxNumber: | 5184864303 | ||||||||
Practice Location | |||||||||
Address1: | 44 HOLLAND AVE | ||||||||
Address2: |   | ||||||||
City: | ALBANY | ||||||||
State: | NY | ||||||||
PostalCode: | 122083411 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5184747720 | ||||||||
FaxNumber: | 5184864303 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/13/2009 | ||||||||
LastUpdateDate: | 05/13/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 037423 | NY | Y |   | Pharmacy Service Providers | Pharmacist |   |
No ID Information.