Organization
HUDSON HEADWATERS HEALTH NETWORK
Active
Parent organization
HUDSON HEADWATERS HEALTH NETWORK
Organization subpart
Yes
Provider details
NPI number
Legal business name
HUDSON HEADWATERS HEALTH NETWORK
Authorized official
LAURA PASCO (EXECUTIVE VP, CFO)
(518) 761-0300
Entity
Organization
Contact information
Practice address
11 CROSS ST, BOLTON LANDING, NY 12814-0539
(518) 644-9471
(518) 644-2915
Mailing address
9 CAREY RD, QUEENSBURY, NY 12804-7880
(518) 761-0300
(518) 824-2388
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03290131
—
NY
Enumeration date
07/26/2006
Last updated
02/23/2024
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