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NPI Code Detail

MEDICARE: NORTHEAST NEPHROLOGY ASSOC P C

MEDICARE: NORTHEAST NEPHROLOGY ASSOC 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
1207RN0300XNephrology Physician

General Provider Information

NPI Number : 1851341580
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTHEAST NEPHROLOGY ASSOC P C
Provider Business Mailing Address
First Line : 258 HOOSICK ST
Second Line : SUITE 101
City : TROY
State : NY
Zip : 12180-2444
Country : US
Telephone Number : 518-274-5660
Fax Number : 518-274-5666
Provider Business Practice Location Address
First Line : 258 HOOSICK ST
Second Line : SUITE 101
City : TROY
State : NY
Zip : 12180-2444
Country : US
Telephone Number : 518-274-5660
Fax Number : 518-274-5666
Authorized Official
Title or Position : PRESIDENT
Name : LESLIE STUART GOLDSTEIN
Credential : M.D.
Telephone Number : 518-274-5660
Provider Enumeration Date : 05/11/2006
Last Update Date : 12/03/2013

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Directions to “NORTHEAST NEPHROLOGY ASSOC P C ” Practice Location

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