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General NPI Number Information
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NPI Number | 1558169623
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Entity Type | Organization
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Legal Business Name | JR NURSE PRACTITIONER IN PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 430 FRANKLIN ST STE 2304
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City | SCHENECTADY
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State | NY
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Zip | 12305-2018
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Country | US
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Telephone | 518-788-7983
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Fax | 866-616-2109
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Provider Business Mailing Address
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Address Line | 99 HYDE BLVD
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City | BALLSTON SPA
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State | NY
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Zip | 12020-1607
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Country | US
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Telephone | 518-368-1691
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE ADMINISTRATOR
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Name | KENNETH EDICK
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Credential | PHD
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Telephone | 518-788-7983
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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