Healthcare Provider Details

I. General information

NPI: 1922438209
Provider Name (Legal Business Name): MIGUEL HILARIO CODD NAVY IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WEST AVE SUITE 230
SARATOGA SPRINGS NY
12866-6045
US

IV. Provider business mailing address

1 WEST AVE SUITE 230
SARATOGA SPRINGS NY
12866-6045
US

V. Phone/Fax

Practice location:
  • Phone: 518-583-5300
  • Fax: 518-583-5316
Mailing address:
  • Phone: 518-583-5300
  • Fax: 518-583-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: