Healthcare Provider Details

I. General information

NPI: 1952491599
Provider Name (Legal Business Name): JAMI HAWTHORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MOUNTAIN LEDGE
GANSEVOORT NY
12831-2539
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD SUITE 203
LATHAM NY
12110-2442
US

V. Phone/Fax

Practice location:
  • Phone: 518-584-0355
  • Fax: 518-583-7665
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number204041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: