Healthcare Provider Details

I. General information

NPI: 1356530190
Provider Name (Legal Business Name): BRUCE A PECKAGE DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 STATE ST
ALBANY NY
12203-1611
US

IV. Provider business mailing address

995 STATE ST
ALBANY NY
12203-1611
US

V. Phone/Fax

Practice location:
  • Phone: 518-438-3544
  • Fax: 518-438-4292
Mailing address:
  • Phone: 518-438-3544
  • Fax: 518-438-4292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN002732
License Number StateNY

VIII. Authorized Official

Name: BRUCE A PECKAGE
Title or Position: PRESIDENT
Credential: DPM
Phone: 518-438-3544