Healthcare Provider Details

I. General information

NPI: 1508279423
Provider Name (Legal Business Name): NEAL A. BAILALRGEON M.D.F.A.A.F.P
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 06/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BROAD STREET
KINDERHOOK NY
12106
US

IV. Provider business mailing address

90 BROAD STREET
KINDERHOOK NY
12106
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-7252
  • Fax: 518-758-1963
Mailing address:
  • Phone: 518-758-7252
  • Fax: 518-758-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEAL A BAILLARGEON
Title or Position: OWNER
Credential: F.A.A.F.P
Phone: 518-758-7252