Provider Demographics
NPI:1063691210
Name:EDWARD P. FOLEY DO P.C.
Entity type:Organization
Organization Name:EDWARD P. FOLEY DO P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-477-5900
Mailing Address - Street 1:1955 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1955 FERNDALE RD
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9623
Practice Address - Country:US
Practice Address - Phone:518-477-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194267207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDE2774OtherRR MEDICARE GRP
NY01570772Medicaid
NYP00282554OtherRR MCARE
NYAA0642Medicare PIN
NYDE2774OtherRR MEDICARE GRP
NYX46269Medicare UPIN
NY01570772Medicaid