Provider Demographics
NPI:1215448857
Name:CRESTWOOD HEALTH INC
Entity type:Organization
Organization Name:CRESTWOOD HEALTH INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAGAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:518-435-2315
Mailing Address - Street 1:26 PICOTTE DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1710
Mailing Address - Country:US
Mailing Address - Phone:518-435-2315
Mailing Address - Fax:518-435-2323
Practice Address - Street 1:26 PICOTTE DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1710
Practice Address - Country:US
Practice Address - Phone:518-435-2315
Practice Address - Fax:518-435-2323
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRESTWOOD HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-23
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0269443336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02630459Medicaid