Provider Demographics
NPI:1083864458
Name:WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WHITNEY M. YOUNG, JR. HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHIPPEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-465-4771
Mailing Address - Street 1:920 LARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:849 2ND AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-2085
Practice Address - Country:US
Practice Address - Phone:518-833-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-23
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473565Medicaid
NY331980Medicare Oscar/Certification