Organization
KOINONIA HEALTHCARE
Active
Other names
Koinonia Primary Care and Psychiatric services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT JOHN PAEGLOW M.D. (DIRECTOR)
(518) 689-0282
Entity
Organization
Contact information
Practice address
553 CLINTON AVENUE, ALBANY, NY 12206
(518) 689-0282
Mailing address
553 CLINTON AVENUE, ALBANY, NY 12206
(518) 689-0282
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
60/201542
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01753680
—
NY
01
—
G9202
CDPHP GROUP
NY
Enumeration date
10/03/2006
Last updated
11/03/2011
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