Healthcare Provider Details

I. General information

NPI: 1063774941
Provider Name (Legal Business Name): ORTHOPEDICSNY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 SITTERLY RD
HALFMOON NY
12065
US

IV. Provider business mailing address

121 EVERETT RD SUITE 100
ALBANY NY
12205-1447
US

V. Phone/Fax

Practice location:
  • Phone: 518-688-0247
  • Fax:
Mailing address:
  • Phone: 518-453-9088
  • Fax: 518-689-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANE GERRY
Title or Position: DIRECTO
Credential:
Phone: 518-453-9088