Healthcare Provider Details

I. General information

NPI: 1366765836
Provider Name (Legal Business Name): JILL A. LTAIF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WALKER WAY
ALBANY NY
12205-4995
US

IV. Provider business mailing address

2277 TROY-SCHENECTADY ROAD
NISKAYUNA NY
12309
US

V. Phone/Fax

Practice location:
  • Phone: 518-452-7795
  • Fax:
Mailing address:
  • Phone: 518-347-2099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number043027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: