Organization
ALBANY REGIONAL EYE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN DE BRUEYS (ADMINISTRATOR)
(518) 782-1181
Entity
Organization
Contact information
Practice address
5 JOHNSON RD, LATHAM, NY 12110-3003
(518) 782-1181
Mailing address
5 JOHNSON RD, LATHAM, NY 12110-3003
(518) 782-1181
Taxonomy
Speciality
Code
Description
License number
State
261QS0132X
Ophthalmologic Surgery Clinic/Center
Primary
0153204R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02214982
—
NY
01
—
040191
EMPIRE BC ID NUMBER
NY
Enumeration date
05/24/2006
Last updated
11/01/2016
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