Organization
PHG MEDICAL OFFICE, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD M WERNER MD (OWNER)
(518) 310-3644
Entity
Organization
Contact information
Practice address
1942 MILITARY TPKE, PLATTSBURGH, NY 12901-7375
(518) 310-3644
(518) 310-3645
Mailing address
1942 MILITARY TPKE, PLATTSBURGH, NY 12901-7375
(518) 310-3644
(518) 310-3645
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
096889
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00577410
—
NY
01
—
00577413
MEDICADE PROVIDER NUMBER
NY
01
—
11124926
CAQH
NY
Enumeration date
08/08/2016
Last updated
12/01/2016
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