Healthcare Provider Details

I. General information

NPI: 1568492247
Provider Name (Legal Business Name): UPSTATE INFECTIOUS DISEASES ASSOCIATES, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 NEW SCOTLAND AVE
ALBANY NY
12208-2725
US

IV. Provider business mailing address

404 NEW SCOTLAND AVE
ALBANY NY
12208-2725
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 Number181447
License Number StateNY

VIII. Authorized Official

Name: GINA M KABREHL
Title or Position: PRACTICE MANAGER
Credential:
Phone: 518-435-0662