KOINONIA HEALTHCARE NPI 1225122054

NPI Information

NPI: 1225122054
Provider Name: KOINONIA HEALTHCARE

Other Name: KOINONIA PRIMARY CARE AND PSYCHIATRIC SERVICES

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
553 CLINTON AVENUE
ALBANY, NY
ZIP 12206
Phone: (518) 689-0282
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KOINONIA HEALTHCARE is a primary care clinic center in Albany, NY. KOINONIA HEALTHCARE NPI is 1225122054. The provider is registered as an organization entity type.
The provider Other Name Is Koinonia Primary Care And Psychiatric Services.

The provider's business location address is:

553 CLINTON AVENUE
ALBANY, NY
ZIP 12206
Phone: (518) 689-0282

The provider's authorized official is Robert John Paeglow .
The authorized official title is Director and has the following contact phone number (518) 689-0282.

The CLIA number assigned to this NPI record is 33D0998757 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/3/2006 and was last updated on 11/3/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care	60/201542	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	01753680	MEDICAID	NEW YORK
2	AA1259	MEDICARE ID-TYPE UNSPECIFIED	NEW YORK	MEDICARE GROUP
3	G9202	OTHER	NEW YORK	CDPHP GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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