MEDICARE: COMMUNITY CARE PHYSICIANS, PLLC

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
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1801728217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE PHYSICIANS, PLLC

Provider Business Mailing Address
First Line	:	6 WELLNESS WAY STE 201
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2156
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:

Provider Business Practice Location Address
First Line	:	2546 BALLTOWN RD STE 200
Second Line	:
City	:	SCHENECTADY
State	:	NY
Zip	:	12309-1079
Country	:	US
Telephone Number	:	518-454-9140
Fax Number	:	518-454-9141

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	DEBBY COONS
Credential	:
Telephone Number	:	518-213-0478

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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