Individual
EVERETT ROY FORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
585 TROY SCHENECTADY RD, LATHAM, NY 12110-2811
(518) 785-6004
(518) 785-1702
Mailing address
47 SWEET RD, BALLSTON LAKE, NY 12019-1805
(518) 785-6004
(518) 785-1702
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
103928-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000401336001
BLUE SHIELD OF NENY
—
01
—
01148
MVP
—
01
—
10000672
CDPHP
—
01
—
49E991
EMPIRE BCBS
—
Enumeration date
05/31/2005
Last updated
07/08/2007
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us