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General NPI Number Information
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NPI Number | 1346263290
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Entity Type | Organization
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Legal Business Name | HUDSON HEADWATERS HEALTH NETWORK
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1448 RTE 9
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City | SOUTH GLENS FALLS
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State | NY
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Zip | 12803
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Country | US
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Telephone | 518-761-6961
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Fax | 518-761-1006
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Provider Business Mailing Address
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Address Line | 1 BROAD STREET PLZ PO BOX 357
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City | GLENS FALLS
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State | NY
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Zip | 12801-4390
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Country | US
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Telephone | 518-761-0300
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Fax | 518-745-1378
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | ERIC BURTON
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Credential |
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Telephone | 518-761-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F334110
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License Number State | NY
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