Healthcare Provider Details

I. General information

NPI: 1750376836
Provider Name (Legal Business Name): ST. PETER'S AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 WASHINGTON AVE SUITE 201
ALBANY NY
12206-1056
US

IV. Provider business mailing address

1375 WASHINGTON AVE SUITE 201
ALBANY NY
12206-1056
US

V. Phone/Fax

Practice location:
  • Phone: 518-533-3420
  • Fax: 518-533-3424
Mailing address:
  • Phone: 518-533-3420
  • Fax: 518-533-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number261QA1903X
License Number StateNY

VIII. Authorized Official

Name: MR. JAMES A TORRE
Title or Position: EXECUTIVE DIRECTOR/ADMINISTRATOR
Credential:
Phone: 518-533-3420