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NPI Code Detail

MEDICARE: PRIMARY CARE HEALTH PARTNERS - NEW YORK LLP

MEDICARE: PRIMARY CARE HEALTH PARTNERS - NEW YORK LLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician
2207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003861782
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIMARY CARE HEALTH PARTNERS - NEW YORK LLP
Provider Business Mailing Address
First Line : 600 BLAIR PARK RD STE 285
Second Line :
City : WILLISTON
State : VT
Zip : 05495-7586
Country : US
Telephone Number : 802-288-1140
Fax Number : 802-288-1144
Provider Business Practice Location Address
First Line : 159 MARGARET ST
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12901-1893
Country : US
Telephone Number : 518-562-0151
Fax Number :
Authorized Official
Title or Position : COO
Name : JON W ASSELIN
Credential :
Telephone Number : 802-872-4326
Provider Enumeration Date : 05/23/2006
Last Update Date : 06/29/2023

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