Healthcare Provider Details

I. General information

NPI: 1669408068
Provider Name (Legal Business Name): SARATOGA RHEUMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MOUNTAIN LEDGE SUITE C
GANSEVOORT NY
12831-1856
US

IV. Provider business mailing address

5 MOUNTAIN LEDGE SUITE C
GANSEVOORT NY
12831-1856
US

V. Phone/Fax

Practice location:
  • Phone: 518-584-4953
  • Fax: 518-584-7916
Mailing address:
  • Phone: 518-584-4953
  • Fax: 518-584-7916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number180296
License Number StateNY

VIII. Authorized Official

Name: DR. ELLEN F COSGROVE
Title or Position: MD/OWNER
Credential: M.D.
Phone: 518-584-4953