Organization
COLUMBIA MEMORIAL REGIONAL MEDICAL PLLC
Active
Other names
Tannersville Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN T. MAHONEY (CHIEF FINANCIAL OFFICER)
(518) 828-8090
Entity
Organization
Contact information
Practice address
6171 ROUTE 23A, TANNERSVILLE, NY 12485
(518) 589-6843
(518) 589-6844
Mailing address
PO BOX 2000, HUDSON, NY 12534-2000
(518) 697-3258
(518) 828-8183
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03227290
—
NY
Enumeration date
02/15/2021
Last updated
07/21/2021
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