NPIMap

Individual provider Active NPI

Priscela Lizette Kugblenu, PA-C

  • Physician Assistant
  • Loudonville, NY
National Provider Identifier
1669032116
Registry record updated Jun 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
025029 Issued in NY
Practice address
407 Albany Shaker Rd
Loudonville, NY 12211-1900
Phone
(518) 435-1300
NPI assigned
Jun 17, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 025029 NY Primary

Addresses

Primary practice location

407 Albany Shaker Rd
Loudonville, NY 12211-1900

Mailing address

106 N Pine Ave Apt 2
Albany, NY 12203-1737
Phone (518) 512-6321

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200818001504 NY Practitioner - Physician Assistant 0446676761 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saratoga HospitalGroup PAC ID 6406740273, 353 clinicians

Practice addresses (Care Compare)

112 Charlton Rd
Ballston Lake, NY 12019-2547
Phone (518) 587-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saratoga Hospital CurrentSince Jul 21, 2025 Accepting new patients
Saratoga Hospital CurrentSince Jul 21, 2025 Accepting new patients
Saratoga Hospital CurrentSince Jul 21, 2025 Accepting new patients
Saratoga Hospital CurrentSince Jul 21, 2025 Accepting new patients
Saratoga Regional Medical , P.C CurrentSince Jul 21, 2025 Accepting new patients
Oldendorf Medical Services, PLLC CurrentSince Jul 5, 2020 Accepting new patients
Scotia Glenville Family Medicine, P.C. Current Accepting new patients
Saratoga Hospital Past Accepting new patients

Locations

510 Geyser Rd
Ballston Spa, NY 12020
Phone (518) 289-2720

112 Charlton Rd
Charlton, NY 12019
Phone (518) 399-7723

407 Albany Shaker Rd
Loudonville, NY 12211
Phone (518) 435-1280

407 Albany Shaker Rd
Ste 100
Loudonville, NY 12211
Phone (518) 435-1300

1275 Broadway
#106
Menands, NY 12204
Phone (518) 262-9705

15 Maple Dell
Ste 1
Saratoga Springs, NY 12866
Phone (518) 583-7400

24 Hamilton St
Saratoga Springs, NY 12866
Phone (518) 886-5600

3044 Route 50
Saratoga Springs, NY 12866
Phone (518) 886-5800

3065 Route 50
Ste 30
Saratoga Springs, NY 12866
Phone (518) 584-1590

1 West Ave
Ste 300
Saratoga Springs, NY 12866
Phone (518) 693-4699

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1560729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685577600000",
    "number": "1669032116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 N PINE AVE APT 2",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122031737",
            "telephone_number": "518-512-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "407 ALBANY SHAKER RD",
            "city": "LOUDONVILLE",
            "state": "NY",
            "postal_code": "122111900",
            "telephone_number": "518-435-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUGBLENU",
        "first_name": "PRISCELA",
        "middle_name": "LIZETTE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-17",
        "last_updated": "2023-06-01",
        "certification_date": "2023-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "025029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loudonville, NY

Sources for this page

Verify at the official NPI Registry.