Provider Demographics
NPI:1538456595
Name:HEALTHY CAPITAL DISTRICT INITIATIVE
Entity Type:Organization
Organization Name:HEALTHY CAPITAL DISTRICT INITIATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:DANYELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BROOKINS
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:518-462-7049
Mailing Address - Street 1:315 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-3133
Mailing Address - Country:US
Mailing Address - Phone:518-462-7049
Mailing Address - Fax:
Practice Address - Street 1:315 SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-3133
Practice Address - Country:US
Practice Address - Phone:518-462-7049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020288124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty