MEDICARE: ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	176B00000X	Midwife
2	261QM1300X	Multi-Specialty Clinic/Center
3	363A00000X	Physician Assistant
4	363L00000X	Nurse Practitioner
5	207V00000X	Obstetrics & Gynecology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1427394675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:	518-649-4094

Provider Business Practice Location Address
First Line	:	31 LOWER HUDSON AVENUE
Second Line	:	ST PETER'S GYNCEOLOGY
City	:	GREEN ISLAND
State	:	NY
Zip	:	12183-1014
Country	:	US
Telephone Number	:	518-272-9140
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	COURTNEY KNOWLES
Credential	:
Telephone Number	:	518-525-5634

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	10/07/2021

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