Provider Demographics
NPI:1003861782
Name:PRIMARY CARE HEALTH PARTNERS - NEW YORK LLP
Entity type:Organization
Organization Name:PRIMARY CARE HEALTH PARTNERS - NEW YORK LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:W
Authorized Official - Last Name:ASSELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:802-872-4326
Mailing Address - Street 1:600 BLAIR PARK RD STE 285
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7586
Mailing Address - Country:US
Mailing Address - Phone:802-288-1140
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:159 MARGARET ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1893
Practice Address - Country:US
Practice Address - Phone:518-562-0151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02052362Medicaid
NYAA0410Medicare PIN
NYBA1291Medicare PIN