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General NPI Number Information
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NPI Number | 1558192211
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Entity Type | Organization
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Legal Business Name | KOUMANIS MEDICAL, PLLC
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Dates
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Enumeration Date | 08/13/2024
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 5 MAIN ST STE 6
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City | QUEENSBURY
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State | NY
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Zip | 12804-4067
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Country | US
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Telephone | 518-798-2225
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Fax | 518-798-2807
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Provider Business Mailing Address
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Address Line | 13 CHESTER ST
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City | GLENS FALLS
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State | NY
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Zip | 12801-3194
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Country | US
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Telephone | 518-798-2225
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Fax | 518-798-2807
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Authorized Official
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Title or Position | PARTNER
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Name | DR. CHAD DERRICK MACNAUGHTON
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Credential | NP,DC
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Telephone | 518-798-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) 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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation 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 | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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