Healthcare Provider Details

I. General information

NPI: 1003050246
Provider Name (Legal Business Name): AMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE PSYCHIATRY DEPARTMENT
ALBANY NY
12208-3412
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE PSYCHIATRY DEPARTMENT
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 516-547-3032
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number62819
License Number StateNY

VIII. Authorized Official

Name: JULIE CYRIAC
Title or Position: RESIDENT
Credential: M.D.
Phone: 516-547-3032