Caitlin Ross
Individual provider Active NPI Specialist · Ballston Lake, NY
NPI 1780130708 · NPPES record last updated Sep 6, 2016
Key facts
- NPI
- 1780130708
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 1242564 (NY)
- Practice address
- 17 Zani LN
Ballston Lake, NY 12019-1720 - Phone
- (518) 396-6777
- NPI assigned
- Aug 30, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1242564 | NY | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 1242564 | NY | Yes |
Addresses
Primary practice location
17 Zani LN
Ballston Lake, NY 12019-1720
Mailing address
17 Zani LN
Ballston Lake, NY 12019-1720
Phone (518) 396-6777
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1242564 | Other | NY | STUDENTS WITH DISABILITIES (B-2 |
Other providers in Ballston Lake, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.