Provider Demographics
NPI:1386753119
Name:FAMILY PRACTICE OF HUDSON FALLS, PC
Entity type:Organization
Organization Name:FAMILY PRACTICE OF HUDSON FALLS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BALLWEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-747-4117
Mailing Address - Street 1:340A MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HUDSON FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12839
Mailing Address - Country:US
Mailing Address - Phone:518-747-4117
Mailing Address - Fax:518-747-9837
Practice Address - Street 1:340A MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON FALLS
Practice Address - State:NY
Practice Address - Zip Code:12839-1530
Practice Address - Country:US
Practice Address - Phone:518-747-4117
Practice Address - Fax:518-747-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1083685465OtherNPI
NY1013999820OtherNPI
NY1336121516OtherNPI
NY1871575605OtherNPI