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NPI Code Detail

MEDICARE: AJB FAMILY MEDICINE PC

MEDICARE: AJB FAMILY MEDICINE 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
1261QH0100XHealth Service Clinic/Center233710NY

General Provider Information

NPI Number : 1558542969
Entity Type Code : Organization
Provider Name (Legal Business Name) : AJB FAMILY MEDICINE PC
Provider Business Mailing Address
First Line : 57 WOODLAND LN
Second Line :
City : PALENVILLE
State : NY
Zip : 12463-2525
Country : US
Telephone Number : 845-246-3642
Fax Number : 845-246-1612
Provider Business Practice Location Address
First Line : 25 ULSTER AVE
Second Line :
City : SAUGERTIES
State : NY
Zip : 12477-1212
Country : US
Telephone Number : 845-246-3642
Fax Number : 845-246-1612
Authorized Official
Title or Position : PRESIDENT
Name : AMY JEANNE BRUECKNER
Credential : DO
Telephone Number : 845-246-3642
Provider Enumeration Date : 11/14/2007
Last Update Date : 12/09/2007

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