Healthcare Provider Details

I. General information

NPI: 1700196086
Provider Name (Legal Business Name): MEGAN P CODY RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN PELNIK

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 WESTERN AVE SUITE D
ALBANY NY
12203-3440
US

IV. Provider business mailing address

4 ATRIUM DR STE 100 ATTN: CREDENTIALING
ALBANY NY
12205-1441
US

V. Phone/Fax

Practice location:
  • Phone: 518-452-0587
  • Fax: 518-218-0152
Mailing address:
  • Phone: 518-435-2740
  • Fax: 518-649-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015317
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: