Healthcare Provider Details

I. General information

NPI: 1659555415
Provider Name (Legal Business Name): ADULT MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PINNACLE PLACE STE 203
ALBANY NY
12203
US

IV. Provider business mailing address

1 PINNACLE PLACE STE 203
ALBANY NY
12203
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-4700
  • Fax: 518-438-3190
Mailing address:
  • Phone: 518-438-4700
  • Fax: 518-438-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZANNA P BOKA
Title or Position: OWNER
Credential: MD
Phone: 518-638-6700