Healthcare Provider Details

I. General information

NPI: 1770741514
Provider Name (Legal Business Name): DR STEPHEN E CARNEY DR CHRISTOPHER H REILLY DR BRET D GELDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 AIRLINE DR SUITE 204
ALBANY NY
12205-1025
US

IV. Provider business mailing address

10 AIRLINE DRIVE SUITE 204
ALBANY NY
12205
US

V. Phone/Fax

Practice location:
  • Phone: 518-456-6104
  • Fax: 518-456-5041
Mailing address:
  • Phone: 518-456-6104
  • Fax: 518-456-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number430421
License Number StateNY

VIII. Authorized Official

Name: MRS. JOELLA MARIE FALCONIO
Title or Position: OFFICE MANAGER
Credential:
Phone: 518-456-6104