Healthcare Provider Details

I. General information

NPI: 1407840804
Provider Name (Legal Business Name): JOEL L SOLOMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S WESTERN AVE
QUEENSBURY NY
12804-3323
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-798-6400
  • Fax: 518-798-4105
Mailing address:
  • Phone: 518-761-0300
  • Fax: 518-824-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number124635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: