EVERETT FORMAN PC (NPI# 1144402983) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144402983 |
| Entity Type | Organization |
| Organization Name | EVERETT FORMAN PC |
| Other Organization Name | MEDI SCENE |
| Practice Address |
585 Troy Schenectady Rd Latham NY 12110-2811 |
| Mailing Address |
47 Sweet Rd Ballston Lake NY 12019-1805 |
| Practice Telephone | 5187856004 |
| Practice Fax Number | 5187851702 |
| Mailing Telephone | 5188996657 |
| Mailing Fax Number | 5188990023 |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2007-12-19 |
| Authorized Official Name | DR. EVERETT ROY FORMAN (PRESIDENT) |
| Authorized Official Telephone | 5188996657 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | BLUE SHJELD OF NENY | 000401336001 | 01 |
| NY | EMPIRE BLUEXBLUE SHIELD | 49E991 | 01 |
| NY | MVP | 01148 | 01 |
| NY | MEDICARE RAILROAD | 080031557 | 01 |
| NY | CDPHP | 10000672 | 01 |
| Other Name | Type Code |
|---|---|
| Medi Scene | Doing Business As Name - Organization |
| Street Address |
585 TROY SCHENECTADY RD |
| City | LATHAM |
| State | NY |
| Zip Code | 12110-2811 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528061967 | Everett Roy Forman | General Practice | 585 Troy Schenectady Rd, Latham, NY 12110-2811 | 2005-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154963973 | Bayley Archinal | Physical Therapist | 711 Troy-schenectady Road, Ste 216, Latham, NY 12110 | 2019-10-14 |
| 1114410701 | Kimberly A. Hostig Licensed Clinical Social Worker Pllc | Clinic/Center | 8 Stanley Cir Ste 11, Latham, NY 12110 | 2018-06-08 |
| 1710477260 | Colleen Phillips | Physical Therapist | 711 Troy Schenectady Rd Ste 216, Latham, NY 12110 | 2018-05-10 |
| 1528574779 | Deborah Cannon | Specialist | 33c Waterford Avenue East, Latham, NY 12110 | 2017-12-26 |
| 1730600149 | Michael Navarrete | Dentist | 231 Wade Road Ext Unit 101, Latham, NY 12110 | 2017-07-06 |
| 1316499452 | Colonie Asc LLC | Clinic/Center | 207 Troy-schenectady Rd, Colonie, NY 12110 | 2016-10-25 |
| 1720539950 | Tania M Durante | Pharmacist | 1057 Troy-schenectady Rd, Latham, NY 12110 | 2016-10-24 |
| 1417344987 | New York Epilepsy Medicine, PC | Clinic/Center | 3 Lear Jet Ln Ste 203, Latham, NY 12110 | 2015-04-22 |
| 1346664752 | Lauren Gannon | Registered Nurse | 95 Forts Ferry Road, Latham, NY 12110 | 2014-02-06 |
| 1649522756 | Natasha Kapsaroff-ruiz | Nurse Practitioner | 654 Watervliet Shaker Rd, Latham, NY 12110 | 2012-10-12 |
| Find all providers in zip 12110 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821535592 | St. Peter's Health Partners Medical Associates, PC | General Practice | 713 Troy Schenectady Rd Ste 304, St. Peter's Ob/gyn At Latham, Latham, NY 12110-2490 | 2017-01-19 |
| 1104160316 | Albany Medical College | General Practice | 713 Troy Schenectady Rd Ste 126, Latham, NY 12110-2490 | 2012-11-15 |
| 1528061967 | Everett Roy Forman | General Practice | 585 Troy Schenectady Rd, Latham, NY 12110-2811 | 2005-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003420472 | Theodean Smith-lawrence | General Practice | 7 Smoke Rise Ln, Wappingers Falls, NY 12590-1220 | 2020-09-03 |
| 1891304325 | Christopher R. Page, M.d., Pllc | General Practice | 46 Route 25a Ste 6, Setauket, NY 11733-2807 | 2020-07-30 |
| 1740804442 | Aliza Hakimian | General Practice | 15 Hill Park Ave Apt 2n, Great Neck, NY 11021-3709 | 2020-05-29 |
| 1962022152 | Lynnette Lallave - Cortes | General Practice | 2 Seaman Ave Apt 1d, New York, NY 10034-2904 | 2020-04-17 |
| 1942829759 | Northeasttelemedicine | General Practice | 483 Coolidge Hill Rd, Diamond Point, NY 12824 | 2020-04-11 |
| 1578198826 | Online Care Medicine PC | General Practice | 26 Oldox Rd, Delmar, NY 12054-2943 | 2020-03-06 |
| 1821621301 | Donnet Andrea Riley | General Practice | 781 Palmer Rd Apt 3a, Bronxville, NY 10708-3309 | 2020-02-12 |
| 1104463652 | Ohad Shimshon Bentur | General Practice | 450 E 63rd St Apt 3g, New York, NY 10065-7957 | 2019-12-03 |
| 1285278291 | Echo Clinical Associates LLC | General Practice | 56 Echo Ave., Ste 1, Miller Place, NY 11764-2454 | 2019-11-01 |
| 1710528583 | Debra Heverly | General Practice | 2315 Whirlpool St # 415, Niagara Falls, NY 14305-2413 | 2019-10-03 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on EVERETT FORMAN PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.