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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396724894 | NPPES |
| New York | Other | P00055451 | RR MEDICARE |
| New York | MEDICAID | 02340921 | RR MEDICARE |
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