Healthcare Provider Details

I. General information

NPI: 1447554704
Provider Name (Legal Business Name): PETER J. POCILUYKO CASAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2010
Last Update Date: 12/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 REMSEN ST
COHOES NY
12047-2605
US

IV. Provider business mailing address

50 REMSEN ST
COHOES NY
12047-2605
US

V. Phone/Fax

Practice location:
  • Phone: 518-235-1100
  • Fax: 518-235-0079
Mailing address:
  • Phone: 518-235-1100
  • Fax: 518-235-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11566
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: