Organization
COLUMBIA COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRY ROBINSON (CONTROLLER)
(518) 672-7408
Entity
Organization
Contact information
Practice address
201 MAIN STREET RTE 217, PHILMONT, NY 12565-0785
(518) 672-7408
(518) 672-4721
Mailing address
PO BOX 785, PHILMONT, NY 12565-0785
(518) 672-7408
(518) 672-4721
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1021300N
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00400261003
BLUE SHIELD PROVIDER NUMB
NY
05
—
00473345
—
NY
01
—
10031340
CDPHP PROVIDER NUMBER
NY
01
—
714144F
MVP PROVIDER NUMBER
NY
Enumeration date
09/08/2006
Last updated
03/14/2025
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