Healthcare Provider Details

I. General information

NPI: 1891784955
Provider Name (Legal Business Name): PLATTSBURGH ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 MARGARET ST
PLATTSBURGH NY
12901-1755
US

IV. Provider business mailing address

450 MARGARET ST
PLATTSBURGH NY
12901-1755
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-3144
  • Fax: 518-561-3155
Mailing address:
  • Phone: 518-561-3144
  • Fax: 518-561-3155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. KJELL DAHLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 518-561-3144