Healthcare Provider Details

I. General information

NPI: 1437080967
Provider Name (Legal Business Name): TELEMEDICINE PHYSICAL CARE PROVIDER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE Y
ALBANY NY
12207-2922
US

IV. Provider business mailing address

418 BROADWAY STE Y
ALBANY NY
12207-2922
US

V. Phone/Fax

Practice location:
  • Phone: 408-256-3180
  • Fax: 408-372-0839
Mailing address:
  • Phone: 408-256-3180
  • Fax: 408-372-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: PRIYANKA WALI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 408-256-3180