Healthcare Provider Details

I. General information

NPI: 1760894208
Provider Name (Legal Business Name): NEAL A BAILLARGEON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 BROAD STREET
KINDERHOOK NY
12106-0766
US

IV. Provider business mailing address

PO BOX 766 90 BROAD STREET
KINDERHOOK NY
12106-0766
US

V. Phone/Fax

Practice location:
  • Phone: 518-758-7252
  • Fax: 151-875-8193
Mailing address:
  • Phone: 518-758-7252
  • Fax: 151-875-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number161495
License Number StateNY

VIII. Authorized Official

Name: DR. NEAL ARTHUR BAILLARGEON
Title or Position: PHYSCIAN
Credential: M.D,.F.A.A.F.P
Phone: 518-758-7252