Healthcare Provider Details

I. General information

NPI: 1063411783
Provider Name (Legal Business Name): ALFONSO F.J. PRIETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PALISADES DR
ALBANY NY
12205-1438
US

IV. Provider business mailing address

2 PALISADES DR
ALBANY NY
12205-1438
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-2000
  • Fax: 518-458-1524
Mailing address:
  • Phone: 518-458-2000
  • Fax: 518-458-1524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number208187
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number208187
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: