PHG Medical Office, LLP

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

096889 Issued in NY

Legal business name

PHG MEDICAL OFFICE, LLP

Practice address

1942 Military Tpke
Plattsburgh, NY 12901-7375

Phone

(518) 310-3644

Fax

(518) 310-3645

NPI assigned

Aug 8, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Donald M Werner, MD

Title

Owner

Phone

(518) 310-3644

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1470614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480550400000",
    "number": "1184178121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 MILITARY TPKE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129017375",
            "telephone_number": "518-310-3644",
            "fax_number": "518-310-3645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 MILITARY TPKE",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "129017375",
            "telephone_number": "518-310-3644",
            "fax_number": "518-310-3645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHG MEDICAL OFFICE, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-08",
        "last_updated": "2016-12-01",
        "status": "A",
        "authorized_official_last_name": "WERNER",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-310-3644",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "096889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICADE PROVIDER NUMBER",
            "identifier": "00577413",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11124926",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00577410",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vincent Persaud, MD
• Ashley Peters, PHARM.D.
• Daniel J Peters
• Emily Amelia Petro, CCC-SLP
• Dhiraj Phadtare, P.T.
• Brenda M. Phillips, MD
• Brigitte Louise Phillips, M.S.
• Dove Phillips, LMHC, ATR-BC
• Michael Edward Phillips, MD
• Robert E. Phillips, A.B.O.C.

• Primary Care Clinic/Center in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.