Active NPI
Juanito T So, MD
- Geriatric Medicine (Internal Medicine) Physician
- Amsterdam, NY
National Provider Identifier
1659370146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 137258-1
- Practice address
- 380 Guy Park Ave
St. Mary'S Hospital, Fam HLTH CNTR at Carondelet Pavili
Amsterdam, NY 12010 - Phone
- (518) 841-7415
- Fax
- (518) 841-7422
- NPI assigned
- Jul 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 137258/-1 | NY | |
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 137258-1 | NY | Primary |
Addresses
Primary practice location
380 Guy Park Ave
St. Mary'S Hospital, Fam HLTH CNTR at Carondelet Pavili
Amsterdam, NY 12010
Mailing address
427 Guy Park Ave - Primary & Specialty Care Dept.
St. Mary'S Hospital at Amsterdam
Amsterdam, NY 12010
Phone (518) 841-7430
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10010372 | Other | NY | C.D.P.H.P. |
| 00462193 | Medicaid | NY | |
| 11506 | Other | NY | M.V.P. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 137258/-1 | NY | MD | Internal Medicine Physician |
| 137258-1 | NY | MD | Geriatric Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382572800000",
"number": "1659370146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.",
"address_2": "ST. MARY'S HOSPITAL AT AMSTERDAM",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "12010",
"telephone_number": "518-841-7430",
"fax_number": "518-841-7121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "380 GUY PARK AVE",
"address_2": "ST. MARY'S HOSPITAL, FAM HLTH CNTR AT CARONDELET PAVILI",
"city": "AMSTERDAM",
"state": "NY",
"postal_code": "12010",
"telephone_number": "518-841-7415",
"fax_number": "518-841-7422"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SO",
"first_name": "JUANITO",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-18",
"last_updated": "2013-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "137258/-1",
"primary": false
},
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NY",
"license": "137258-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "C.D.P.H.P.",
"identifier": "10010372",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00462193",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "M.V.P.",
"identifier": "11506",
"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 24, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.