Everett Forman PC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

EVERETT FORMAN PC

Doing business as

Medi Scene

Practice address

585 Troy Schenectady Rd
Latham, NY 12110-2811

Phone

(518) 785-6004

Fax

(518) 785-1702

NPI assigned

Dec 4, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Everett Roy Forman, M.D.NPI 1528061967

Title

President

Phone

(518) 899-6657

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Medi Scene Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Everett Roy Forman, M.D.

  • General Practice Physician
  • Latham, NY
  • NPI 1528061967
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1144402983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 SWEET RD",
            "city": "BALLSTON LAKE",
            "state": "NY",
            "postal_code": "120191805",
            "telephone_number": "518-899-6657",
            "fax_number": "518-899-0023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "585 TROY SCHENECTADY RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121102811",
            "telephone_number": "518-785-6004",
            "fax_number": "518-785-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERETT FORMAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "FORMAN",
        "authorized_official_first_name": "EVERETT",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-899-6657",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "01148",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHJELD OF NENY",
            "identifier": "000401336001",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "080031557",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDPHP",
            "identifier": "10000672",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUEXBLUE SHIELD",
            "identifier": "49E991",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi Scene",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Russell Esposito
• Ayuk B Etang
• Suzanne Evangelista, RN
• Kateylyn Cecille Evans, PHARMD
• Jason Eveleth, MS. ED, LMHC
• Evergreen Care Services LLC
• Sydney Ezzo
• John Joseph Faccone, RPH
• Kimberly Fahey, PT
• Miel Norwood Fajen, ED.D.

• General Practice Physician in Latham, NY
• Providers in Latham, NY by specialty
• General Practice Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.