Detore, Joanne

Detore, Joanne is an individual health care provider with primary practice located at 2 Broad Street Plz Broad Street Medical Group, Glens Falls NY 12801-4363. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Detore, Joanne can be contacted via phone (518) 926-1770.

Contact Information

Primary practice address
2 Broad Street Plz Broad Street Medical Group Glens Falls NY 12801-4363
Phone: (518) 926-1770
Fax: (518) 926-1799
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 006825 New York

Profile Details

NPI number 1396724894
LBN Legal business name Detore, Joanne
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 12th, 2006
Last updated Jun 6th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396724894 NPPES
New York Other P00055451 RR MEDICARE
New York MEDICAID 02340921 RR MEDICARE

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