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General NPI Number Information
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NPI Number | 1144731738
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Entity Type | Organization
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Legal Business Name | WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 900 LARK DR
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City | ALBANY
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State | NY
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Zip | 12207-1300
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Country | US
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Telephone | 518-465-6330
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Fax | 518-242-4773
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Provider Business Mailing Address
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Address Line | 920 LARK DR
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City | ALBANY
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State | NY
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Zip | 12207-1300
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Country | US
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Telephone | 518-465-4771
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MARY CONNOLLY
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Credential |
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Telephone | 518-591-4461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 0101205R
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License Number State | NY
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