Healthcare Provider Details

I. General information

NPI: 1306109301
Provider Name (Legal Business Name): WHITNEY M. YOUNG JR. HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 LARK DR
ALBANY NY
12207-1300
US

IV. Provider business mailing address

920 LARK DR
ALBANY NY
12207-1300
US

V. Phone/Fax

Practice location:
  • Phone: 518-465-4771
  • Fax: 518-242-4770
Mailing address:
  • Phone: 518-465-4771
  • Fax: 518-242-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number261Q00000X
License Number StateNY

VIII. Authorized Official

Name: MR. DAVID H SHIPPEE
Title or Position: CEO
Credential:
Phone: 518-465-4771