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General NPI Number Information
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NPI Number | 1245459841
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Entity Type | Organization
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Legal Business Name | PRIME CARE PHYSICIANS, P.L.L.C.
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 16 DANFORTH ST
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City | HOOSICK FALLS
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State | NY
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Zip | 12090-1226
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Country | US
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Telephone | 518-458-2000
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Fax | 518-458-1524
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Provider Business Mailing Address
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Address Line | 4 ATRIUM DR SUITE 100
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City | ALBANY
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State | NY
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Zip | 12205-1441
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Country | US
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Telephone | 518-435-2704
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Fax | 518-458-2610
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Authorized Official
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Title or Position | DIRETOR OF ADMINISTRATION
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Name | MR. MICHAEL WHALEN
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Credential |
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Telephone | 518-435-2704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 54964
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License Number State | NY
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