Healthcare Provider Details

I. General information

NPI: 1275759680
Provider Name (Legal Business Name): MONTGOMERY COUNTY PUBLIC HEALTH DEPT.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PARK ST
FONDA NY
12068-4830
US

IV. Provider business mailing address

20 PARK ST
FONDA NY
12068-4830
US

V. Phone/Fax

Practice location:
  • Phone: 518-853-3531
  • Fax: 518-853-8218
Mailing address:
  • Phone: 518-853-3531
  • Fax: 518-853-8218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM D CONBOY
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: RN, MS
Phone: 518-853-3531