Healthcare Provider Details

I. General information

NPI: 1811150261
Provider Name (Legal Business Name): JANAY FAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2008
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE ALBANY MEDICAL CENTER DEPARTMENT OF PSYCHIATRY
ALBANY NY
12208-3412
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE ALBANY MEDICAL CENTER DEPARTMENT OF PSYCHIATRY
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5511
  • Fax: 518-262-6111
Mailing address:
  • Phone: 518-262-5511
  • Fax: 518-262-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number62671
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number259863
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: