Healthcare Provider Details

I. General information

NPI: 1861740813
Provider Name (Legal Business Name): GLENS FALLS HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NORTH RD THE MEDICAL CENTER AT WILTON-SPECIALTY SUITE
WILTON NY
12831-1308
US

IV. Provider business mailing address

PO BOX 304 ADIRONDACK MEDICAL SERVICES
GLENS FALLS NY
12801-0304
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-4827
  • Fax: 518-926-1934
Mailing address:
  • Phone: 518-926-6999
  • Fax: 518-926-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL SCIMECA
Title or Position: VICE PRESIDENT PHYSICIAN PRACTICES
Credential:
Phone: 518-926-5902