Provider Demographics
NPI:1154744753
Name:ST. PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:ST. PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-525-1585
Mailing Address - Street 1:279 TROY RD
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9518
Mailing Address - Country:US
Mailing Address - Phone:518-694-3053
Mailing Address - Fax:518-694-3056
Practice Address - Street 1:279 TROY RD
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-9518
Practice Address - Country:US
Practice Address - Phone:518-694-3053
Practice Address - Fax:518-694-3056
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. PETERS HEALTH PARTNERS MEDICAL ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-03
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty