Healthcare Provider Details

I. General information

NPI: 1437418795
Provider Name (Legal Business Name): SARATOGA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CHARLTON RD
BALLSTON LAKE NY
12019-2547
US

IV. Provider business mailing address

PO BOX 412655
BOSTON MA
02241-2655
US

V. Phone/Fax

Practice location:
  • Phone: 518-399-7723
  • Fax: 518-399-6428
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHLEEN STAHURA
Title or Position: DIRECTOR
Credential:
Phone: 518-583-8346