Healthcare Provider Details

I. General information

NPI: 1144302886
Provider Name (Legal Business Name): ERNEST M ENZIEN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 EMPIRE DR STE 100
RENSSELAER NY
12144-5730
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-475-9518
  • Fax: 518-286-4859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number225801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: