Healthcare Provider Details

I. General information

NPI: 1003844606
Provider Name (Legal Business Name): NORTHEAST EMERGENCY MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 NOTT ST @ ELLIS HOSPITAL ER DEPT.
SCHENECTADY NY
12308-2425
US

IV. Provider business mailing address

PO BOX 1568 428 CLIFTON CORPORATE PARK
CLIFTON PARK NY
12065-0807
US

V. Phone/Fax

Practice location:
  • Phone: 518-383-5450
  • Fax: 518-383-4223
Mailing address:
  • Phone: 518-383-5450
  • Fax: 518-383-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STANLEY W DOCYK
Title or Position: PRESIDENT
Credential: MD
Phone: 518-383-5450