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General NPI Number Information
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NPI Number | 1790796035
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Entity Type | Organization
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Legal Business Name | COMMUNITY CARE PHYSICIANS, PLLC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 6 WELLNESS WAY STE 106
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City | LATHAM
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State | NY
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Zip | 12110-2142
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Country | US
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Telephone | 518-237-7363
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Fax | 518-237-8995
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Provider Business Mailing Address
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Address Line | 711 TROY SCHENECTADY RD STE 203
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City | LATHAM
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State | NY
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Zip | 12110-2461
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Country | US
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Telephone | 518-782-3700
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Fax | 518-782-3799
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | DEBBY COONS
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Credential |
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Telephone | 518-213-0478
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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 |
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License Number State | NY
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