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General NPI Number Information
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NPI Number | 1699256305
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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 | 08/22/2018
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Last Update Date | 12/18/2018
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Provider Practice Location Address
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Address Line | 1245 HILLSIDE DR
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City | WATERVLIET
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State | NY
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Zip | 12189-2406
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Country | US
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Telephone | 518-629-3270
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Fax | 518-629-3262
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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 | 518-591-4459
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. DAVID SHIPPEE
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Credential |
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Telephone | 518-591-4459
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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 |
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License Number State |
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