Healthcare Provider Details

I. General information

NPI: 1407366057
Provider Name (Legal Business Name): DR KEVIN GEORGE, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CENTRAL AVE STE 375
ALBANY NY
12205-5094
US

IV. Provider business mailing address

30 KARNER RD UNIT 13385
ALBANY NY
12212-7259
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-2481
  • Fax: 518-489-4149
Mailing address:
  • Phone: 518-608-4476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN WAYNE GEORGE
Title or Position: CEO
Credential: MD
Phone: 518-867-5319