Provider Demographics
NPI:1154351419
Name:ADLER, HOWARD S (PA-C)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:ADLER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 MAPLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9618
Mailing Address - Country:US
Mailing Address - Phone:518-732-4656
Mailing Address - Fax:
Practice Address - Street 1:396 BROADWAY
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4626
Practice Address - Country:US
Practice Address - Phone:845-334-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0040451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02101059Medicaid
NY02101059Medicaid
S82477Medicare UPIN