Provider Demographics
NPI:1407907215
Name:PLANNED PARENTHOOD OF THE NORTH COUNTRY NEW YORK, INC.
Entity Type:Organization
Organization Name:PLANNED PARENTHOOD OF THE NORTH COUNTRY NEW YORK, INC.
Other - Org Name:PLANNED PARENTHOOD OF NORTHERN NEW YORK, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-546-2771
Mailing Address - Street 1:160 STONE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-3250
Mailing Address - Country:US
Mailing Address - Phone:315-788-8065
Mailing Address - Fax:315-222-7432
Practice Address - Street 1:160 STONE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3250
Practice Address - Country:US
Practice Address - Phone:315-788-8065
Practice Address - Fax:315-222-7432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2201201R251B00000X, 261QA0005X
261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062844Medicaid
NY00583697Medicaid
NYD78479Medicare UPIN
NYS28221Medicare UPIN
NY56390FMedicare ID - Type UnspecifiedTINA O'NEIL
56390AMedicare PIN
NYS28223Medicare UPIN
NYRA4530Medicare ID - Type UnspecifiedSYLVIA REIMER
NY00583697Medicaid
NY01062844Medicaid