# ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821535592
- **Legal business name:** ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, PC
- **Authorized official:** JANICE MACKE (CFO)
- **Authorized official phone:** (518) 525-6931

## Contact information

- **Practice address:** 713 TROY SCHENECTADY RD STE 304, ST. PETER'S OB/GYN AT LATHAM, LATHAM, NY 12110-2490
- **Practice address phone:** (518) 786-6270
- **Practice address fax:** (518) 786-6276
- **Mailing address:** PO BOX 14890, ST. PETER'S PAYER CREDENTIALING, ALBANY, NY 12212-4890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/19/2017
- **Last updated:** 01/19/2017