Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 203943 | NY |
NPI | 1285605857 |
---|---|
Provider Name | Kevin C Albert |
First Address | Valley Falls, NY 12185-1916 |
Second Address | Troy, NY 12180-2075 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2006 |
Last Update Date | 05/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01720456 | (05) | NY |
10002411 | CDPHP (01) | NY |