Healthcare Provider Details

I. General information

NPI: 1962464800
Provider Name (Legal Business Name): THE ENDOCRINE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 06/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVE SUITE 300
ALBANY NY
12206-1098
US

IV. Provider business mailing address

1365 WASHINGTON AVE SUITE 300
ALBANY NY
12206-1098
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-4704
  • Fax: 518-489-0512
Mailing address:
  • Phone: 518-489-4704
  • Fax: 518-489-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK FRUITERMAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 518-489-4704