Healthcare Provider Details

I. General information

NPI: 1023381100
Provider Name (Legal Business Name): WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 12/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SHERIDAN AVE
ALBANY NY
12206-2920
US

IV. Provider business mailing address

920 LARK DRIVE WHITNEY M. YOUNG JR. INC.
ALBANY NY
12207
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number0101205R
License Number StateNY

VIII. Authorized Official

Name: DAVID HAROLD SHIPPEE
Title or Position: PRESIDENT & CEO
Credential:
Phone: 518-591-4459