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General NPI Number Information
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NPI Number | 1316499452
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Entity Type | Organization
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Legal Business Name | COLONIE ASC LLC
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 03/12/2020
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Provider Practice Location Address
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Address Line | 207 TROY-SCHENECTADY RD
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City | COLONIE
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State | NY
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Zip | 12110
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Country | US
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Telephone | 518-423-7784
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Fax |
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Provider Business Mailing Address
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Address Line | 207 TROY SCHENECTADY RD
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City | LATHAM
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State | NY
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Zip | 12110-5446
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Country | US
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Telephone | 518-538-9128
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Fax | 518-389-2933
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. EDWARD J WLADIS
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Credential | MD
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Telephone | 518-423-7784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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