MEDICARE: ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1275766032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSOCIATED COMMUNITY ACTION OF THE NORTH EAST ADIRONDACK REGION, INC.

Provider Business Mailing Address
First Line	:	39 FARRELL RD
Second Line	:
City	:	WILLSBORO
State	:	NY
Zip	:	12996-3904
Country	:	US
Telephone Number	:	518-963-4275
Fax Number	:	518-963-8862

Provider Business Practice Location Address
First Line	:	2885 ESSEX RD
Second Line	:
City	:	ESSEX
State	:	NY
Zip	:	12936-2317
Country	:	US
Telephone Number	:	518-963-8800
Fax Number	:	518-963-8802

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ROBIN A PIERCE
Credential	:	CPA
Telephone Number	:	518-963-4275

Provider Enumeration Date	:	08/27/2009
Last Update Date	:	05/21/2010

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