Healthcare Provider Details

I. General information

NPI: 1124066295
Provider Name (Legal Business Name): ST. LAWRENCE CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEROY ST
POTSDAM NY
13676-1786
US

IV. Provider business mailing address

PO BOX 5080
POTSDAM NY
13676-5080
US

V. Phone/Fax

Practice location:
  • Phone: 315-261-5920
  • Fax: 315-265-0878
Mailing address:
  • Phone: 315-261-5920
  • Fax: 315-265-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number161770
License Number StateNY

VIII. Authorized Official

Name: DR. ALEXANDRU B STOIAN
Title or Position: OWNER
Credential: MD
Phone: 315-265-3072