Individual
DR. MICHAEL P HOMENICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
551 BAY RD, QUEENSBURY, NY 12804-1441
(518) 798-4056
(518) 798-4255
Mailing address
551 BAY RD, QUEENSBURY, NY 12804-1441
(518) 798-4056
(518) 798-4255
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
008202
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000463033002
BLUE SHIELD
NY
05
—
01035914
—
NY
01
—
41136
MOHAWK VALLEY PHYSICIANS
NY
Enumeration date
12/28/2006
Last updated
07/08/2007
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