Healthcare Provider Details

I. General information

NPI: 1174572978
Provider Name (Legal Business Name): ADIRONDACK EMERGENCY MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 SHOPRITE BLVD ROUTE 209
ELLENVILLE NY
12428-5632
US

IV. Provider business mailing address

30 PROSPECT AVE FL 1 C/O EMERGENCY TREATMENT ASSOCIATES
HUDSON NY
12534-2908
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-6400
  • Fax: 845-647-2076
Mailing address:
  • Phone: 518-751-1016
  • Fax: 518-751-1020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN G KEENE
Title or Position: PRESIDENT AND CEO
Credential: M.D.
Phone: 518-751-1016