Healthcare Provider Details

I. General information

NPI: 1528890282
Provider Name (Legal Business Name): CDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2024
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NEW SCOTLAND AVE
ALBANY NY
12208-3474
US

IV. Provider business mailing address

3397 CARMAN RD
SCHENECTADY NY
12303-5319
US

V. Phone/Fax

Practice location:
  • Phone: 518-549-6670
  • Fax:
Mailing address:
  • Phone: 518-221-6875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: ADINE MARIE ALPHONSE
Title or Position: RN
Credential:
Phone: 518-549-6670