Provider Demographics
NPI:1972255115
Name:2542 TELEHEALTH LLC
Entity type:Organization
Organization Name:2542 TELEHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DNP FNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEMPSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DNP FNP-BC
Authorized Official - Phone:518-483-0233
Mailing Address - Street 1:1467 COUNTY ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:NORTH BANGOR
Mailing Address - State:NY
Mailing Address - Zip Code:12966-2817
Mailing Address - Country:US
Mailing Address - Phone:518-483-0233
Mailing Address - Fax:
Practice Address - Street 1:1467 COUNTY ROUTE 22
Practice Address - Street 2:
Practice Address - City:NORTH BANGOR
Practice Address - State:NY
Practice Address - Zip Code:12966-2817
Practice Address - Country:US
Practice Address - Phone:518-483-0233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1545350OtherLA MEICAID