Healthcare Provider Details

I. General information

NPI: 1992925986
Provider Name (Legal Business Name): PRIME CARE PHYSICIANS, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 QUAKER RD
QUEENSBURY NY
12804-1718
US

IV. Provider business mailing address

4 ATRIUM DR SUITE 100
ALBANY NY
12205-1441
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-1083
  • Fax: 518-793-0953
Mailing address:
  • Phone: 518-435-2704
  • Fax: 518-458-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54964
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number54964
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number54964
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54964
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number54964
License Number StateNY
# 6
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number54964
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL WHALEN
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 518-435-2704