Healthcare Provider Details

I. General information

NPI: 1114137544
Provider Name (Legal Business Name): FULTON COUNTY PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2714 ST HWY 29
JOHNSTOWN NY
12095-0415
US

IV. Provider business mailing address

2714 ST HWY 29 P.O.BOX 415
JOHNSTOWN NY
12095-0415
US

V. Phone/Fax

Practice location:
  • Phone: 518-736-5720
  • Fax: 518-762-1382
Mailing address:
  • Phone: 518-736-5720
  • Fax: 518-762-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1116L001
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. IRINA GELMAN
Title or Position: DIRECTOR OF PUBLIC HEALTH
Credential: DPM
Phone: 518-736-5720