NPIMap

Organization Active NPI

Eugene K. Merecki, MD PC

Doing business as Malta Family Medicine

  • Primary Care Clinic/Center
  • Ballston Spa, NY
National Provider Identifier
1962527630
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
180894 Issued in NY
Legal business name
EUGENE K. MERECKI, MD PC
Doing business as
Malta Family Medicine
Practice address
100 Saratoga Village Blvd Ste 34
Ballston Spa, NY 12020-3738
Phone
(518) 899-2632
Fax
(518) 899-6418
NPI assigned
Mar 20, 2007
Last updated
Jul 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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

Authorized official

Name
Eugene K Merecki, MDNPI 1720070808
Title
Owner
Phone
(518) 899-2632

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)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 180894 NY Primary

Addresses

Primary practice location

100 Saratoga Village Blvd Ste 34
Ballston Spa, NY 12020-3738

Mailing address

100 Saratoga Village Blvd Ste 34
Ballston Spa, NY 12020-3738
Phone (518) 899-2632

Other identifiers 1

IdentifierTypeStateIssuer
AA1411OtherNYNATIONAL GOVERNMENT SERVICES

Other names 1

  • Malta Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090211000136 NY Part B Supplier - Clinic/Group Practice 4183789977 Receives reassigned benefits from 3 practitioners
Practice locations: Malta, NY

National Provider Directory

National Provider Directory

Locations

6 Medical Park Dr
Ste 208
Malta, NY 12020
Phone (518) 899-2632

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1962527630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SARATOGA VILLAGE BLVD STE 34",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120203738",
            "telephone_number": "518-899-2632",
            "fax_number": "518-899-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SARATOGA VILLAGE BLVD STE 34",
            "city": "BALLSTON SPA",
            "state": "NY",
            "postal_code": "120203738",
            "telephone_number": "518-899-2632",
            "fax_number": "518-899-6418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUGENE K. MERECKI, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "MERECKI",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-899-2632",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "180894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL GOVERNMENT SERVICES",
            "identifier": "AA1411",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Malta Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ballston Spa, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.

Verify at the official NPI Registry.