1023381100 NPI number — WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.

Table of content: (NPI 1023381100)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023381100 NPI number — WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
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:
6
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:
1023381100
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 LARK DRIVE
Provider Second Line Business Mailing Address:
WHITNEY M. YOUNG JR. INC.
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-465-4771
Provider Business Mailing Address Fax Number:
518-242-4770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 SHERIDAN AVE
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:
12206-2920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-465-4771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SHIPPEE
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
HAROLD
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
518-591-4459

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  0101205R , 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: 00473565 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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