Healthcare Provider Details

I. General information

NPI: 1023240454
Provider Name (Legal Business Name): ADIRONDACK REGISTERED PROFESSIONAL NURSING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SARATOGA VILLAGE BLVD STE 51
MALTA NY
12020-3738
US

IV. Provider business mailing address

100 SARATOGA VILLAGE BLVD STE 51
MALTA NY
12020-3738
US

V. Phone/Fax

Practice location:
  • Phone: 518-886-8251
  • Fax: 518-400-1069
Mailing address:
  • Phone: 518-886-8251
  • Fax: 518-400-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number33D2001059
License Number StateNY

VIII. Authorized Official

Name: MRS. KRISTEN POMMENVILLE
Title or Position: EXECUTIVE DIRECTOR OF OPERATIONS
Credential:
Phone: 518-886-8251