Healthcare Provider Details

I. General information

NPI: 1104919752
Provider Name (Legal Business Name): DR. SARAH L ELMENDORF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH L DISTEFANO M.D.

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UPSTATE INFECTIOUS DISEASES ASSOCIATES 404 NEW SCOTLAND AVE
ALBANY NY
12208
US

IV. Provider business mailing address

UPSTATE INFECTIOUS DISEASES ASSOCIATES 404 NEW SCOTLAND AVE
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-0662
  • Fax: 518-435-0664
Mailing address:
  • Phone: 518-435-0662
  • Fax: 518-435-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number153286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: