Healthcare Provider Details

I. General information

NPI: 1124580154
Provider Name (Legal Business Name): CASEY EOGHAN PADRAIG HLADIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 MYRTLE AVE STE 5
ALBANY NY
12208-3797
US

IV. Provider business mailing address

391 MYRTLE AVE STE 5
ALBANY NY
12208-3797
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5640
  • Fax:
Mailing address:
  • Phone: 518-262-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number338998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: