Healthcare Provider Details

I. General information

NPI: 1831303569
Provider Name (Legal Business Name): ADIRONDACK ORAL & MAXILLOFACIAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PALISADES DR SUITE 210
ALBANY NY
12205-6433
US

IV. Provider business mailing address

5 PALISADES DR SUITE 210
ALBANY NY
12205-6433
US

V. Phone/Fax

Practice location:
  • Phone: 518-348-0634
  • Fax: 518-426-3221
Mailing address:
  • Phone: 518-348-0634
  • Fax: 518-426-3221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number045890
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number053589
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number055974
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number050384
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number049895
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50933
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number034917
License Number StateNY

VIII. Authorized Official

Name: DR. TIMOTHY LYNCH
Title or Position: CEO
Credential: DDS
Phone: 518-348-0634