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General NPI Number Information
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NPI Number | 1417362963
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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 | 06/24/2014
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 854 ROUTE 212 SAUGERTIES WELLNESS CENTER
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City | SAUGERTIES
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State | NY
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Zip | 12477-4619
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Country | US
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Telephone | 845-246-2804
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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 | COURTNEY KNOWLES
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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 | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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