Healthcare Provider Details

I. General information

NPI: 1801851829
Provider Name (Legal Business Name): CTP NEWTON MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 NEW LOUDON RD
LATHAM NY
12110
US

IV. Provider business mailing address

588 NEW LOUDON RD
LATHAM NY
12110
US

V. Phone/Fax

Practice location:
  • Phone: 518-785-2662
  • Fax: 518-786-6547
Mailing address:
  • Phone: 518-785-2662
  • Fax: 518-786-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILLIAN MANUPELLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 518-785-2662