Healthcare Provider Details

I. General information

NPI: 1811524697
Provider Name (Legal Business Name): JARED SWEENEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 03/24/2020
Certification Date: 03/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE, DEPT. OF NEUROSURGERY
ALBANY NY
12208-2277
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE, DEPT. OF NEUROSURGERY
ALBANY NY
12208-2277
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5088
  • Fax: 518-262-5400
Mailing address:
  • Phone: 518-262-5088
  • Fax: 518-262-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number64384
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: