Healthcare Provider Details

I. General information

NPI: 1205192598
Provider Name (Legal Business Name): SARATOGA SCHENECTADY GASTROENTEROLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NOTT ST SUITE 207
SCHENECTADY NY
12308-2589
US

IV. Provider business mailing address

PO BOX 569 848 ROUTE 50
BURNT HILLS NY
12027-0569
US

V. Phone/Fax

Practice location:
  • Phone: 518-831-1500
  • Fax: 518-377-1677
Mailing address:
  • Phone: 518-831-1500
  • Fax: 518-377-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number154613
License Number StateNY

VIII. Authorized Official

Name: MOLLIE MYERS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 518-831-1500