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General NPI Number Information
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NPI Number | 1821178682
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Entity Type | Organization
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Legal Business Name | NEWTONVILLE PEDIATRICS & INTERNAL MEDICINE
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 564 NEW LOUDON RD
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City | LATHAM
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State | NY
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Zip | 12110-5336
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Country | US
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Telephone | 518-783-1445
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Fax | 518-783-4622
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Provider Business Mailing Address
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Address Line | 564 NEW LOUDON RD
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City | LATHAM
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State | NY
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Zip | 12110-5336
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Country | US
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Telephone | 518-783-1445
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Fax | 518-783-4622
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOANNE MARIE FOGARTY
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Credential | MD
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Telephone | 518-783-1445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 195064
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License Number State | NY
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