Provider Demographics
NPI:1477682755
Name:RENSSELAER COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:RENSSELAER COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYFRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WACHUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-270-2626
Mailing Address - Street 1:1600 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3410
Mailing Address - Country:US
Mailing Address - Phone:518-270-2626
Mailing Address - Fax:518-270-2638
Practice Address - Street 1:1600 7TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3410
Practice Address - Country:US
Practice Address - Phone:518-270-2626
Practice Address - Fax:518-270-2638
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENSSELAER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-05
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9293L001252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03003770Medicaid
NY00473652Medicaid