Healthcare Provider Details

I. General information

NPI: 1093789497
Provider Name (Legal Business Name): ADIRONDACK INTERNAL MEDICINE & PEDIATRICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 11/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2249 STATE ROUTE 86 SUITE 3
SARANAC LAKE NY
12983-5644
US

IV. Provider business mailing address

2249 STATE ROUTE 86 SUITE 3
SARANAC LAKE NY
12983-5644
US

V. Phone/Fax

Practice location:
  • Phone: 518-891-3845
  • Fax: 518-891-1236
Mailing address:
  • Phone: 518-891-3845
  • Fax: 518-891-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ANN D BECKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 518-891-3845