| Glenridge Family Medicine | |
|
15 Glenridge Rd Glenville NY 12302-4520 | |
| (518) 399-0909 | |
| (518) 399-2640 |
| Full Name | Glenridge Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 15 Glenridge Rd, Glenville, New York |
| Authorized Official Name and Position | Lauris Jon Petersen (CEO/PRESIDENT) |
| Authorized Official Contact | 5183990909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenridge Family Medicine 15 Glenridge Rd Glenville NY 12302-4520 Ph: (518) 399-0909 | Glenridge Family Medicine 15 Glenridge Rd Glenville NY 12302-4520 Ph: (518) 399-0909 |
| NPI Number | 1659563989 |
|---|---|
| Provider Enumeration Date | 08/10/2007 |
| Last Update Date | 08/10/2007 |
| Medicare PECOS PAC ID | 9638153976 |
|---|---|
| Medicare Enrollment ID | O20040615001124 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659563989 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 213320 (New York) | Primary |
| Provider Name | Lauris J Petersen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629152301 PECOS PAC ID: 0648254995 Enrollment ID: I20040617000227 |
Ellis Primary Care - Glenville Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 115 Saratoga Rd Ste 200, Glenville, NY 12302 Phone: 518-243-3360 | |
Dr Paul Baumgarten Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 123 Saratoga Rd 2-1, The Foot Doctor, Glenville, NY 12302 Phone: 518-346-6000 |