Healthcare Provider Details

I. General information

NPI: 1962512723
Provider Name (Legal Business Name): NORTHEAST MOBILITY CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EVERETT RD
ALBANY NY
12205-6417
US

IV. Provider business mailing address

115 EVERETT RD
ALBANY NY
12205-6417
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-3646
  • Fax: 518-453-0919
Mailing address:
  • Phone: 518-438-3646
  • Fax: 518-453-0919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KELSEY GORDON
Title or Position: OWNER
Credential:
Phone: 518-339-2499