Provider Demographics
NPI:1457024218
Name:SCHENECTADY FAMILY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SCHENECTADY FAMILY HEALTH SERVICES, INC.
Other - Org Name:HOMETOWN HEALTH CENTERS DENTAL AT MCCLELLAN STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-370-1441
Mailing Address - Street 1:1044 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12307-1508
Mailing Address - Country:US
Mailing Address - Phone:518-370-1441
Mailing Address - Fax:518-395-9431
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:DENTAL SUITE
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-370-1441
Practice Address - Fax:518-395-9431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-28
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02995513Medicaid
NY53099AOtherMEDICARE PIN
NY331833OtherMEDICARE OSCAR