Healthcare Provider Details

I. General information

NPI: 1780694059
Provider Name (Legal Business Name): ADIRONDACK MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 WAWBEEK AVE
TUPPER LAKE NY
12986-2038
US

IV. Provider business mailing address

114 WAWBEEK AVE
TUPPER LAKE NY
12986-2038
US

V. Phone/Fax

Practice location:
  • Phone: 518-359-3355
  • Fax: 518-359-9055
Mailing address:
  • Phone: 518-359-3355
  • Fax: 518-359-9055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J LABA
Title or Position: CFO
Credential:
Phone: 518-897-2301