Organization
EXECUTIVE WOODS AMBULATORY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE R. FLIK MD (MEDICAL DIRECTOR)
(518) 453-2361
Entity
Organization
Contact information
Practice address
3 ATRIUM DR, SUITE 150, ALBANY, NY 12205-1417
(518) 453-2361
(518) 453-1594
Mailing address
3 ATRIUM DR, SUITE 150, ALBANY, NY 12205-1417
(518) 453-2361
(518) 453-1594
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0101219R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401075000
BSNENY PROVIDER NUMBER
NY
01
—
014594
EMPIRE BC PROVIDER NUMBER
NY
05
—
02107211
—
NY
01
—
10043997
CDPHP PROVIDER NUMBER
NY
01
—
1488
MVP PROVIDER NUMBER
NY
Enumeration date
04/10/2006
Last updated
07/23/2025
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