Provider Demographics
NPI:1871533216
Name:CAPITAL REGION ORTHOPAEDIC ASSOCIATES, PC
Entity type:Organization
Organization Name:CAPITAL REGION ORTHOPAEDIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGR
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:AKULLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-292-2670
Mailing Address - Street 1:1367 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1043
Mailing Address - Country:US
Mailing Address - Phone:518-489-2666
Mailing Address - Fax:518-489-5933
Practice Address - Street 1:1367 WASHINGTON AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1043
Practice Address - Country:US
Practice Address - Phone:518-489-2666
Practice Address - Fax:518-489-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00573708Medicaid
VT1006451Medicaid
NY1419OtherCDPHP GROUP #
VT1006451Medicaid
NY0210900001Medicare NSC
NYCN1389Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP#
NY00573708Medicaid