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General NPI Number Information
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NPI Number | 1013879998
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Entity Type | Organization
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Legal Business Name | STEPHEN CARSON PHYSICIAN ASSISTANT
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Dates
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Enumeration Date | 11/28/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 632 PLANK RD STE 103
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City | CLIFTON PARK
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State | NY
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Zip | 12065-4883
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Country | US
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Telephone | 518-414-5706
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Fax | 518-309-6213
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Provider Business Mailing Address
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Address Line | 641 GROOMS RD # 186
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City | CLIFTON PARK
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State | NY
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Zip | 12065-5912
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Country | US
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Telephone | 607-316-1583
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Fax | 607-316-1583
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN CARSON
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Credential | PA
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Telephone | 607-316-1583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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