1568591840 NPI number — RENSSELAER COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1164157624)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568591840 NPI number — RENSSELAER COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RENSSELAER COUNTY HEALTH DEPARTMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568591840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 7TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12180-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-270-2626
Provider Business Mailing Address Fax Number:
518-270-2638

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-270-2626
Provider Business Practice Location Address Fax Number:
518-270-2638
Provider Enumeration Date:
03/05/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WACHUNAS
Authorized Official First Name:
MARYFRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
518-270-2626

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  9293L001 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01426255 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".