Healthcare Provider Details

I. General information

NPI: 1053365171
Provider Name (Legal Business Name): ANESTHESIOLOGISTS OF GLENS FALLS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARK ST ANESTHESIA DEPARTMENT
GLENS FALLS NY
12801-4413
US

IV. Provider business mailing address

PO BOX 1357
WILLISTON VT
05495-1357
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-5127
  • Fax: 518-926-5252
Mailing address:
  • Phone: 800-720-1664
  • Fax: 207-753-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT PODOLSKY
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 518-926-5127