Provider Demographics
NPI:1609214394
Name:BIFARO, JOANNE VIRGINIA (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:VIRGINIA
Last Name:BIFARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:VIRGINIA
Other - Last Name:DANNENHOFFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:391 MYRTLE AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3513
Practice Address - Country:US
Practice Address - Phone:518-207-2273
Practice Address - Fax:518-207-2293
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285466207Q00000X
MA256128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04502989Medicaid
NYJ400328073Medicare PIN