Provider Demographics
NPI:1083732192
Name:COUNTY OF MONROE
Entity Type:Organization
Organization Name:COUNTY OF MONROE
Other - Org Name:MONROE COUNTY DEPARTMENT OF PUBLIC HEALTH EI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMISSIONER OF PUBLIC HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, MS
Authorized Official - Phone:585-753-2989
Mailing Address - Street 1:111 WESTFALL ROAD
Mailing Address - Street 2:ROOM 976
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4647
Mailing Address - Country:US
Mailing Address - Phone:585-753-6666
Mailing Address - Fax:585-753-5115
Practice Address - Street 1:111 WESTFALL ROAD
Practice Address - Street 2:ROOM 976
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4647
Practice Address - Country:US
Practice Address - Phone:585-753-6666
Practice Address - Fax:585-753-5115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MONROE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 252Y00000X
NY060000152459251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355835Medicaid