MEDICARE: ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	207RI0011X	Interventional Cardiology Physician
4	207RP1001X	Pulmonary Disease Physician
5	261QM1300X	Multi-Specialty Clinic/Center
6	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1740802131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 14890
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12212-4890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 ROUTE 9
Second Line	:	ALBANY ASSOCIATES IN CARDIOLOGY
City	:	HALFMOON
State	:	NY
Zip	:	12065-2421
Country	:	US
Telephone Number	:	518-458-2000
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	COURTNEY KNOWLES
Credential	:
Telephone Number	:	518-525-5634

Provider Enumeration Date	:	05/08/2020
Last Update Date	:	10/06/2021

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