Healthcare Provider Details

I. General information

NPI: 1285667634
Provider Name (Legal Business Name): ADIRONDACK PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 BROAD ST
GLENS FALLS NY
12801-4381
US

IV. Provider business mailing address

84 BROAD ST
GLENS FALLS NY
12801-4381
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-9538
  • Fax: 518-798-9576
Mailing address:
  • Phone: 518-798-9538
  • Fax: 518-798-9576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN C. BRAICO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 518-798-9538