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General NPI Number Information
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NPI Number | 1831811553
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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 | 09/19/2022
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 400 PATROON CREEK BLVD STE 108
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City | ALBANY
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State | NY
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Zip | 12206-5014
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Country | US
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Telephone | 518-445-4325
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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 & ENROLLMENT MANAGER
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Name | GARY TERK
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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 | 176B00000X
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Taxonomy Name | Midwife
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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 | 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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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology 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 | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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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 | 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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