Provider Demographics
NPI:1598940264
Name:MONTGOMERY COUNTY
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY
Other - Org Name:MONTGOMERY COUNTY PUBLIC HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONBOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:518-853-3531
Mailing Address - Street 1:20 PARK ST
Mailing Address - Street 2:PO BOX 1500
Mailing Address - City:FONDA
Mailing Address - State:NY
Mailing Address - Zip Code:12068-4830
Mailing Address - Country:US
Mailing Address - Phone:518-853-3531
Mailing Address - Fax:518-853-8218
Practice Address - Street 1:20 PARK ST
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068-4830
Practice Address - Country:US
Practice Address - Phone:518-853-3531
Practice Address - Fax:518-853-8218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
NY2825200R251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1457577868Medicaid
NY55795BMedicare PIN