Healthcare Provider Details

I. General information

NPI: 1801971817
Provider Name (Legal Business Name): FAMILY EAR NOSE AND THROAT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 STATE HIGHWAY 30 SUITE 204
AMSTERDAM NY
12010
US

IV. Provider business mailing address

5010 STATE HIGHWAY 30 SUITE 204
AMSTERDAM NY
12010
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-8185
  • Fax: 518-842-8189
Mailing address:
  • Phone: 518-842-8185
  • Fax: 518-842-8189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DENISE D COOK
Title or Position: OFFICE MANAGER
Credential:
Phone: 518-842-8185