Healthcare Provider Details

I. General information

NPI: 1174553093
Provider Name (Legal Business Name): ALBANY MEDICAL COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE MC 139
ALBANY NY
12208-3412
US

IV. Provider business mailing address

1275 BROADWAY # MC106
MENANDS NY
12204-2638
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3131
  • Fax: 518-262-3597
Mailing address:
  • Phone: 518-262-9705
  • Fax: 518-262-9705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VINCENT P VERDILE
Title or Position: DEAN
Credential: M.D.
Phone: 518-262-6008