Healthcare Provider Details

I. General information

NPI: 1750395562
Provider Name (Legal Business Name): ADIRONDACK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 STATE ROUTE 86
SARANAC LAKE NY
12983-5644
US

IV. Provider business mailing address

2233 STATE ROUTE 86 PO BOX 471
SARANAC LAKE NY
12983-5644
US

V. Phone/Fax

Practice location:
  • Phone: 518-897-2378
  • Fax: 518-891-7615
Mailing address:
  • Phone: 518-897-2378
  • Fax: 518-891-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number020896
License Number StateNY

VIII. Authorized Official

Name: ADELE LYON
Title or Position: PROF CREDENTIALING COORDINATOR
Credential:
Phone: 518-897-4725