Healthcare Provider Details

I. General information

NPI: 1003860354
Provider Name (Legal Business Name): EDMUND FRANCIS FALLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 NORTH RD
WILTON NY
12831-1308
US

IV. Provider business mailing address

PO BOX 304
GLENS FALLS NY
12801-0304
US

V. Phone/Fax

Practice location:
  • Phone: 518-581-7256
  • Fax: 518-926-1965
Mailing address:
  • Phone: 518-926-6992
  • Fax: 518-926-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number108707
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: