Provider Demographics
NPI:1154343168
Name:HUDSON HEADWATERS HEALTH NETWORK
Entity type:Organization
Organization Name:HUDSON HEADWATERS HEALTH NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-761-0300
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-480-0108
Practice Address - Street 1:MAIN STREET AND PELON ROAD
Practice Address - Street 2:
Practice Address - City:INDIAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12842-0684
Practice Address - Country:US
Practice Address - Phone:518-648-5707
Practice Address - Fax:518-648-6160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUDSON HEADWATERS HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6846363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty