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General NPI Number Information
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NPI Number | 1861065856
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Entity Type | Organization
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Legal Business Name | ALBANY KETAMINE MEDICAL INFUSIONS PLLC
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 523 WESTERN AVE
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City | ALBANY
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State | NY
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Zip | 12203-1617
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Country | US
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Telephone | 518-249-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 7 WEMBLEY CT
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City | ALBANY
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State | NY
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Zip | 12205-3851
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Country | US
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Telephone | 518-249-5700
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Fax | 518-942-2248
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | PHILIP HANSEN
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Credential | MD
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Telephone | 518-249-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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