Healthcare Provider Details

I. General information

NPI: 1588697957
Provider Name (Legal Business Name): CHRISTIAN A BOTTISTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

266 STATE HIGHWAY 67
AMSTERDAM NY
12010-7311
US

IV. Provider business mailing address

5044 STATE HIGHWAY 30
AMSTERDAM NY
12010-7534
US

V. Phone/Fax

Practice location:
  • Phone: 518-842-1852
  • Fax: 518-615-1900
Mailing address:
  • Phone: 518-842-1852
  • Fax: 518-615-1900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTIAN ANTHONY BOTTISTI SR.
Title or Position: CEO
Credential:
Phone: 518-842-1852