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NPI Code Detail

MEDICARE: HUDSON HEADWATERS HEALTH NETWORK

MEDICARE: HUDSON HEADWATERS HEALTH NETWORK
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 Physician

General Provider Information

NPI Number : 1679977714
Entity Type Code : Organization
Provider Name (Legal Business Name) : HUDSON HEADWATERS HEALTH NETWORK
Provider Business Mailing Address
First Line : 9 CAREY RD
Second Line :
City : QUEENSBURY
State : NY
Zip : 12804-7880
Country : US
Telephone Number : 518-761-0300
Fax Number : 518-745-1378
Provider Business Practice Location Address
First Line : 319 BROADWAY
Second Line :
City : FORT EDWARD
State : NY
Zip : 12828-1221
Country : US
Telephone Number : 518-761-0300
Fax Number : 518-824-2318
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : CHRISTOPHER TOURNIER
Credential :
Telephone Number : 518-761-0300
Provider Enumeration Date : 10/17/2014
Last Update Date : 10/17/2014

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Directions to “HUDSON HEADWATERS HEALTH NETWORK ” Practice Location

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