=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093582801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PURCELL INTEGRATIVE OSTEOPATHIC, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2023
-----------------------------------------------------
Last Update Date | 12/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1462 ERIE BLVD STE 3
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12305-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-901-2800
-----------------------------------------------------
Fax | 518-240-4347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1462 ERIE BLVD STE 3
-----------------------------------------------------
City | SCHENECTADY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12305-1026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-901-2800
-----------------------------------------------------
Fax | 518-240-4347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL W PURCELL
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 518-810-5002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------