Healthcare Provider Details

I. General information

NPI: 1356357172
Provider Name (Legal Business Name): SARATOGA PET ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 EMMA LN
CLIFTON PARK NY
12065-3763
US

IV. Provider business mailing address

130 CANVASS ST
COHOES NY
12047-3049
US

V. Phone/Fax

Practice location:
  • Phone: 518-373-8270
  • Fax: 518-373-8235
Mailing address:
  • Phone: 518-235-0827
  • Fax: 518-237-3106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRIAN K MCCANDLESS
Title or Position: MANAGING MEMBER
Credential:
Phone: 518-235-0827