Healthcare Provider Details

I. General information

NPI: 1841732765
Provider Name (Legal Business Name): ADIRONDACK HEALTH REGIONAL MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 BROAD ST STE A
PLATTSBURGH NY
12901-3301
US

IV. Provider business mailing address

2233 STATE ROUTE 86 ATTN: PROVIDER ENROLLMENT
SARANAC LAKE NY
12983-5644
US

V. Phone/Fax

Practice location:
  • Phone: 518-566-9452
  • Fax: 518-566-9831
Mailing address:
  • Phone: 518-897-4725
  • Fax: 518-897-2423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: IRWIN LIEB
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 518-897-2704