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	License Number	License Number State
1	261Q00000X	Clinic/Center
2	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1821846999
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	:

Provider Business Practice Location Address
First Line	:	3 ATRIUM DRIVE
Second Line	:	ENTRANCE A
City	:	ALBANY
State	:	NY
Zip	:	12205-1432
Country	:	US
Telephone Number	:	518-435-1234
Fax Number	:	518-435-0079

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

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	06/02/2026

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