Healthcare Provider Details

I. General information

NPI: 1922506021
Provider Name (Legal Business Name): LARRY JOSEPH ALBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3409
US

IV. Provider business mailing address

35 MARWOOD ST
ALBANY NY
12209-1216
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6948
  • Fax: 518-549-6958
Mailing address:
  • Phone: 518-453-6321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number433300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: