Healthcare Provider Details

I. General information

NPI: 1154933901
Provider Name (Legal Business Name): ALAINA JORDAN FOUST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10B MADISON AVENUE EXT
ALBANY NY
12203-7314
US

IV. Provider business mailing address

PO BOX 654
GALWAY NY
12074-0654
US

V. Phone/Fax

Practice location:
  • Phone: 518-867-3061
  • Fax:
Mailing address:
  • Phone: 518-545-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: