1952309536 NPI number — ALBANY COUNTY

Table of content: (NPI 1952309536)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952309536 NPI number — ALBANY COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALBANY COUNTY
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:
1952309536
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
780 ALBANY SHAKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12211-1058
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-869-2231
Provider Business Mailing Address Fax Number:
518-869-1713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 ALBANY SHAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12211-1058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-869-2231
Provider Business Practice Location Address Fax Number:
518-869-1290
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SLATKY
Authorized Official First Name:
LARRY
Authorized Official Middle Name:
I
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
518-869-2231

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  0153302N , 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: 0153302N . This is a "NYSDOH CERTIFICATE LICENSE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00309260 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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