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General NPI Number Information
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NPI Number | 1174404040
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Entity Type | Organization
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Legal Business Name | ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 315 S MANNING BLVD
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City | ALBANY
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State | NY
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Zip | 12208-1707
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Country | US
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Telephone | 518-525-5351
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14890
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City | ALBANY
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State | NY
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Zip | 12212-4890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | GARY TERK
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Credential |
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Telephone | 518-525-5634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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