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Organization
EMPIRE STATE PHYSICIAN PLLC
Active
Organization
EMPIRE STATE PHYSICIAN PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR R HENRIQUES MD (OWNER)
(518) 433-0205
Entity
Organization
Contact information
Practice address
180 WASHINGTON AVENUE EXT, ALBANY, NY 12203-5304
(518) 456-7831
Mailing address
11 RUSO DR, MENANDS, NY 12204-1313
(518) 433-0205
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
231783
NY
Other
Enumeration date
12/19/2012
Last updated
12/19/2012
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