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General NPI Number Information
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NPI Number | 1891068490
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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 | 02/14/2012
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 2125 RIVER RD STE 100B
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City | SCHENECTADY
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State | NY
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Zip | 12309-1108
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Country | US
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Telephone | 518-980-5825
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Fax | 518-980-5826
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Provider Business Mailing Address
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Address Line | 6 WELLNESS WAY STE 201
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City | LATHAM
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State | NY
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Zip | 12110-2156
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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 | SENIOR CREDENTIALING COORDINATOR
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Name | DIANE M STAMAS
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Credential |
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Telephone | 518-782-3742
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 240305
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License Number State | NY
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