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General NPI Number Information
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NPI Number | 1386730752
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Entity Type | Organization
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Legal Business Name | SARATOGA FAMILY MEDICINE,PLLC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 100 SARATOGA VILLAGE BLVD SUITE 34
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City | MALTA
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State | NY
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Zip | 12020-3737
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Country | US
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Telephone | 518-899-9090
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Fax | 518-899-9098
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Provider Business Mailing Address
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Address Line | 100 SARATOGA VILLAGE BLVD SUITE 34
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City | MALTA
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State | NY
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Zip | 12020-3737
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Country | US
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Telephone | 518-899-9090
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Fax | 518-899-9098
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIANNE A MUSTAFA
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Credential | M.D.
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Telephone | 518-899-9090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 226100
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License Number State | NY
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