MANDY BETH BLACK (NPI# 1386049385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386049385 |
| Entity Type | Individual |
| Full Name | MANDY BETH BLACK |
| Credential | FNP-C |
| Practice Address |
279 Troy Rd Rensselaer NY 12144-9518 |
| Mailing Address |
Po Box 14890 Albany NY 12212-4890 |
| Practice Telephone | 5182861922 |
| Mailing Telephone | 5185255634 |
| Enumeration Date | 2014-11-03 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
339091 | NY | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 03993955 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 158 Saratoga Ave, Waterford, NY 121882205 | 5182861922 | |
| 314 S Manning Blvd, Albany, NY 122081708 | 5184375700 | |
| 55 Mohawk St Ste 105, Cohoes, NY 120472600 | 5182861922 |
| Street Address |
279 TROY RD |
| City | RENSSELAER |
| State | NY |
| Zip Code | 12144-9518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124021241 | Kristin Marie Cooke | Nurse Practitioner | 279 Troy Rd, Rensselaer, NY 12144-9518 | 2005-05-23 |
| 1679184873 | Ali Sadrudin Khoja | Optometrist | 279 Troy Rd, Rensselaer, NY 12144-9518 | 2020-08-11 |
| 1558745091 | Colleen Hickey | Physician Assistant | 279 Troy Rd, Rensselaer, NY 12144-9518 | 2015-07-15 |
| 1154744753 | St. Peters Health Partners Medical Associates PC | Psychiatry & Neurology | 279 Troy Rd, Rensselaer, NY 12144-9518 | 2014-02-03 |
| 1366787020 | St Peters Health Partners Medical Associates, PC | Radiology | 279 Troy Rd, St. Peter's Medical Imaging, Rensselaer, NY 12144-9521 | 2012-12-06 |
| 1407190044 | Samaritan Hospital of Troy, New York | Psychologist | 279 Troy Rd, Rensselaer, NY 12144-9756 | 2012-11-20 |
| 1700131604 | Prime Care Physicians, Pllc | Radiology | 279 Troy Rd, Route 4, Rensselaer, NY 12144-9499 | 2012-07-17 |
| 1649541152 | Community Care Physicians, PC | Obstetrics & Gynecology | 279 Troy Rd, Rensselaer County Plaza, Rensselaer, NY 12144-9499 | 2012-01-16 |
| 1740593094 | Gaetano Matthew Cristalli | Family Medicine | 279 Troy Rd, Family Medical Group, Rensselaer, NY 12144-9518 | 2010-07-15 |
| 1346476967 | Anne Barbara Houacine | Technician/Technologist | 279 Troy Rd, Rensselaer, NY 12144-9499 | 2009-06-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053955567 | Sherisa Moore | Registered Nurse | 17 River Chase Drive, B, Rensselaer, NY 12144 | 2019-10-29 |
| 1811553738 | Joel C Campbell | Licensed Practical Nurse | 419 Northgreenbush Road, Rensselaer, NY 12144 | 2019-05-16 |
| 1063956688 | Ashley F Bertorelli | Physical Therapist | 476 N Greenbush Rd Ste 3, Rensselaer, NY 12144 | 2016-12-16 |
| 1184066060 | Stefanie L Walsh | Physical Therapist | 2 Empire Dr Ste 202, Rensselaer, NY 12144 | 2013-07-22 |
| 1821347550 | C & L Transport Inc. | Non-emergency Medical Transport (VAN) | 27 Columbia Street, Rensselaer, NY 12144 | 2012-09-10 |
| 1639448376 | Harry William Letko | Licensed Practical Nurse | 456b North Greenbush Rd, Rensselaer, NY 12144 | 2011-12-27 |
| 1285901827 | Tammy Ellen Barbour | Registered Nurse | 25 Vanrensselaer Dr., Rensselaer Academy, Rensselaer, NY 12144 | 2011-11-28 |
| 1144474693 | Peter Patrick Martin | Occupational Therapist | 24 Oak Street, Rensselaer, NY 12144 | 2008-11-11 |
| 1487820064 | Kathleen Powell | Pharmacist | 501 Columbia Turnpike, Price Chopper, Rensselaer, NY 12144 | 2008-05-05 |
| 1609065788 | Stefan J Fosco | Audiologist | 2 Empire Dr Ste 204, Rensselaer, NY 12144 | 2007-10-15 |
| Find all providers in zip 12144 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194768010 | Wanda Gay Gifford | Nurse Practitioner | 118 W Drexel Pkwy, Rensselaer, IN 47978-7344 | 2006-06-14 |
| 1124021241 | Kristin Marie Cooke | Nurse Practitioner | 279 Troy Rd, Rensselaer, NY 12144-9518 | 2005-05-23 |
| 1720697451 | Tonya Kay Bonnell | Nurse Practitioner | 123 S Mckinley Ave, Rensselaer, IN 47978-2949 | 2020-07-29 |
| 1124589957 | Sharon A Johnson Fnp LLC | Nurse Practitioner | 1103 E Grace St, Rensselaer, IN 47978-3210 | 2019-03-26 |
| 1144746793 | Nina Statile | Nurse Practitioner | 2 Empire Dr Ste 100, Rensselaer, NY 12144-5730 | 2017-08-16 |
| 1437682317 | Aine Pattengale | Nurse Practitioner | 118 W Drexel Pkwy, Rensselaer, IN 47978-7344 | 2017-04-06 |
| 1952754632 | Jennifer Dewolf | Nurse Practitioner | 2 Empire Dr Ste 100, Capital Region Family Health, Rensselaer, NY 12144-5730 | 2016-07-19 |
| 1942618582 | Marianne Zimmer | Nurse Practitioner | 295 Valley View Blvd, Rensselaer, NY 12144-9307 | 2014-07-28 |
| 1003220724 | Lindsay Bishop | Nurse Practitioner | 2 Empire Dr, Rensselaer, NY 12144-5730 | 2014-06-20 |
| 1053546226 | Mary Jo Elkins | Nurse Practitioner | 919 E Grace St, Rensselaer, IN 47978 | 2009-05-18 |
| Find all providers in RENSSELAER | ||||
| City | RENSSELAER |
| Zip Code | 12144 |
Please comment or provide details below to improve the information on MANDY BETH BLACK.
| 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.