Provider Demographics
NPI:1245399351
Name:ALBANY COUNTY
Entity Type:Organization
Organization Name:ALBANY COUNTY
Other - Org Name:CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SIEGAL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:518-447-4537
Mailing Address - Street 1:175 GREEN STREET
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12202-2011
Mailing Address - Country:US
Mailing Address - Phone:518-447-4537
Mailing Address - Fax:518-447-4577
Practice Address - Street 1:260 S PEARL ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12202-1809
Practice Address - Country:US
Practice Address - Phone:518-447-4555
Practice Address - Fax:518-447-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6901100A261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00554774Medicaid
NY00554774Medicaid