Active NPI
Emily T. Etzkorn, M.D., P.C.
- Internal Medicine Physician
- Amsterdam, NY
National Provider Identifier
1396856530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- EMILY T. ETZKORN, M.D., P.C.
- Practice address
- 5010 State Highway 30
Suite G-02
Amsterdam, NY 12010-7532 - Phone
- (518) 842-0017
- Fax
- (518) 842-7545
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Emily T. Etzkorn, M.D., P.C.
- Title
- President/Corporation Holder
- Phone
- (518) 842-0017
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
5010 State Highway 30
Suite G-02
Amsterdam, NY 12010-7532
Mailing address
5010 State Highway 30
Suite G-02
Amsterdam, NY 12010-7532
Phone (518) 842-0017
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02047565 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101026001217 | NY | Part B Supplier - Clinic/Group Practice | 1557554235 |
Receives reassigned benefits from 8 practitioners Practice locations: Amsterdam, NY |
National Provider Directory
National Provider DirectoryLocations
5010 State Highway 30
Ste G02
Amsterdam, NY 12010
Phone (518) 842-0017
Practitioners & affiliated clinicians
Practitioners 10
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Amsterdam, NY
- NPI 1871554543
Internal Medicine, NY
-
- Psychiatric/Mental Health Nurse Practitioner
- Albany, NY
- NPI 1649623984
-
- Pediatrics Physician
- Madison, WI
- NPI 1063603462
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1287619200000",
"number": "1396856530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5010 STATE HIGHWAY 30",
"address_2": "SUITE G-02",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "120107532",
"telephone_number": "518-842-0017",
"fax_number": "518-842-7545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5010 STATE HIGHWAY 30",
"address_2": "SUITE G-02",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "120107532",
"telephone_number": "518-842-0017",
"fax_number": "518-842-7545"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EMILY T. ETZKORN, M.D., P.C.",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2010-10-21",
"status": "A",
"authorized_official_last_name": "ETZKORN",
"authorized_official_first_name": "EMILY",
"authorized_official_middle_name": "T.",
"authorized_official_title_or_position": "PRESIDENT/CORPORATION HOLDER",
"authorized_official_telephone_number": "518-842-0017",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D., P.C."
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02047565",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Amsterdam, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.