Forman, Everett Roy

Forman, Everett Roy is an individual health care provider with primary practice located at 585 Troy Schenectady Rd , Latham NY 12110-2811. He recently has only one registered license in Allopathic & Osteopathic Physicians / General Practice, which is considered as his primary health care specialty. Forman, Everett Roy can be contacted via phone (518) 785-6004.

Contact Information

Primary practice address
585 Troy Schenectady Rd Latham NY 12110-2811
Phone: (518) 785-6004
Fax: (518) 785-1702
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 103928-1 New York

Profile Details

NPI number 1528061967
LBN Legal business name Forman, Everett Roy
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 31st, 2005
Last updated Jul 8th, 2007 - about 18 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528061967 NPPES
Other 10000672 CDPHP
Other 01148 CDPHP
Other 000401336001 CDPHP
Other 49E991 CDPHP

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