Healthcare Provider Details

I. General information

NPI: 1477550929
Provider Name (Legal Business Name): CYNTHIA ROSE RENAULD-LANSING D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S PEARL ST ST. PETER'S HOSPITAL FAMILY HEALTH CENTER
ALBANY NY
12202-1914
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-449-0100
  • Fax: 518-463-8580
Mailing address:
  • Phone: 518-525-5634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number173802
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: