| 63 Shaker Road-suite 102 | |
|
63 Albany Shaker Rd Suite 102 Albany NY 12204-1030 | |
| (518) 207-2710 | |
| (518) 207-2713 |
| Full Name | 63 Shaker Road-suite 102 |
|---|---|
| Speciality | Internal Medicine |
| Location | 63 Albany Shaker Rd, Albany, New York |
| Authorized Official Name and Position | Paul Gordon (DIR FIN/ADMIN PHYS ENTERPRISE) |
| Authorized Official Contact | 5185251585 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 63 Shaker Road-suite 102 315 S Manning Blvd Albany NY 12208-1707 Ph: (518) 525-1585 | 63 Shaker Road-suite 102 63 Albany Shaker Rd Suite 102 Albany NY 12204-1030 Ph: (518) 207-2710 |
| NPI Number | 1760727325 |
|---|---|
| Provider Enumeration Date | 12/07/2012 |
| Last Update Date | 01/21/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760727325 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
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