Provider Demographics
NPI:1114137544
Name:FULTON COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:FULTON COUNTY PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:518-736-5720
Mailing Address - Street 1:2714 ST HWY 29
Mailing Address - Street 2:P.O.BOX 415
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-0415
Mailing Address - Country:US
Mailing Address - Phone:518-736-5720
Mailing Address - Fax:518-762-1382
Practice Address - Street 1:2714 ST HWY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-0415
Practice Address - Country:US
Practice Address - Phone:518-736-5720
Practice Address - Fax:518-762-1382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1116L001251B00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02057587Medicaid