Healthcare Provider Details

I. General information

NPI: 1548543812
Provider Name (Legal Business Name): COMMUNITY CARE PHYSICIANS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MCCLELLAN STREET
SCHENECTADY NY
12304-1019
US

IV. Provider business mailing address

711 TROY SCHENECTADY RD STE 203
LATHAM NY
12110-2461
US

V. Phone/Fax

Practice location:
  • Phone: 518-372-5637
  • Fax: 518-372-1384
Mailing address:
  • Phone: 518-782-3700
  • Fax: 518-782-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number130500
License Number StateNY

VIII. Authorized Official

Name: DEBBY COONS
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 518-213-0478