Organization
HOOSICK STREET PEDIATRICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT SHAVER (PRACTICE MANAGER)
(518) 273-3732
Entity
Organization
Contact information
Practice address
333 HOOSICK ST, TROY, NY 12180-2042
(518) 273-3732
(518) 273-3732
Mailing address
333 HOOSICK ST, TROY, NY 12180-2042
(518) 273-3732
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
203943-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110002411003
CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.
NY
Enumeration date
12/04/2017
Last updated
12/04/2017
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