Healthcare Provider Details

I. General information

NPI: 1124071709
Provider Name (Legal Business Name): NORTHEAST NEUROSURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 SHAKER RD SUITE 201
ALBANY NY
12204-1030
US

IV. Provider business mailing address

63 SHAKER RD SUITE 201
ALBANY NY
12204-1030
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-1850
  • Fax: 518-446-1861
Mailing address:
  • Phone: 518-446-1850
  • Fax: 518-446-1861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEBORAH HRUSTICH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 518-446-1850