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NPI Code Detail

MEDICARE: COMMUNITY CARE PHYSICIANS, PC

MEDICARE: COMMUNITY CARE PHYSICIANS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician207096NY

General Provider Information

NPI Number : 1073895553
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMUNITY CARE PHYSICIANS, PC
Provider Business Mailing Address
First Line : 711 TROY SCHENECTADY RD STE 203
Second Line :
City : LATHAM
State : NY
Zip : 12110-2461
Country : US
Telephone Number : 518-782-3700
Fax Number : 518-782-3799
Provider Business Practice Location Address
First Line : 1925 CURRY RD
Second Line :
City : SCHENECTADY
State : NY
Zip : 12303-3939
Country : US
Telephone Number : 518-356-5377
Fax Number : 518-881-1489
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : DEBBY COONS
Credential :
Telephone Number : 518-213-0478
Provider Enumeration Date : 09/12/2011
Last Update Date : 04/28/2022

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Directions to “COMMUNITY CARE PHYSICIANS, PC ” Practice Location

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