Individual
MR. JUANITO T SO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
380 GUY PARK AVE, ST. MARY'S HOSPITAL, FAM HLTH CNTR AT CARONDELET PAVILI, AMSTERDAM, NY 12010
(518) 841-7415
(518) 841-7422
Mailing address
427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT., ST. MARY'S HOSPITAL AT AMSTERDAM, AMSTERDAM, NY 12010
(518) 841-7430
(518) 841-7121
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
137258/-1
NY
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
137258-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00462193
—
NY
01
—
10010372
C.D.P.H.P.
NY
01
—
11506
M.V.P.
NY
Enumeration date
07/18/2005
Last updated
10/24/2013
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