Healthcare Provider Details

I. General information

NPI: 1053466425
Provider Name (Legal Business Name): ST. PETER'S HOSPITAL OF THE CITY OF ALBANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PINE WEST PLAZA WASHINGTON AVE EXT
ALBANY NY
12205-5537
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-464-9999
  • Fax: 518-464-9650
Mailing address:
  • Phone: 518-275-4090
  • Fax: 518-275-4004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY KNOWLES
Title or Position: CREDENTIALING & ENROLLMENT MANAGER
Credential:
Phone: 518-525-5634