Provider Demographics
NPI:1558192211
Name:KOUMANIS MEDICAL, PLLC
Entity type:Organization
Organization Name:KOUMANIS MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:MACNAUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP,DC
Authorized Official - Phone:518-798-2225
Mailing Address - Street 1:13 CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3194
Mailing Address - Country:US
Mailing Address - Phone:518-798-2225
Mailing Address - Fax:518-798-2807
Practice Address - Street 1:5 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-4067
Practice Address - Country:US
Practice Address - Phone:518-798-2225
Practice Address - Fax:518-798-2807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty