Provider Demographics
NPI:1447469168
Name:MICHAEL B WHALEN
Entity type:Organization
Organization Name:MICHAEL B WHALEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRODERICK
Authorized Official - Last Name:WHALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-465-7172
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1056
Mailing Address - Country:US
Mailing Address - Phone:518-465-7172
Mailing Address - Fax:518-465-7177
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 227
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1056
Practice Address - Country:US
Practice Address - Phone:518-465-7172
Practice Address - Fax:518-465-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102495207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0248Medicare PIN