Healthcare Provider Details

I. General information

NPI: 1306976394
Provider Name (Legal Business Name): FERTILITY ENHANCEMENT SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EVERETT RD
ALBANY NY
12205
US

IV. Provider business mailing address

130 EVERETT RD
ALBANY NY
12205
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-1007
  • Fax: 518-489-6210
Mailing address:
  • Phone: 518-482-1007
  • Fax: 518-489-6210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number114044
License Number StateNY

VIII. Authorized Official

Name: EDGAR SAUL HENRIGUEL
Title or Position: OWNER
Credential: MD
Phone: 518-482-1007