Provider Demographics
NPI:1629175831
Name:GROUP HEALTH INCORPORATED
Entity Type:Organization
Organization Name:GROUP HEALTH INCORPORATED
Other - Org Name:GHI FAMILY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN BENN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-869-1717
Mailing Address - Street 1:1873 WESTERN AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5028
Mailing Address - Country:US
Mailing Address - Phone:518-869-1044
Mailing Address - Fax:518-869-1965
Practice Address - Street 1:1873 WESTERN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5028
Practice Address - Country:US
Practice Address - Phone:518-869-1044
Practice Address - Fax:518-869-1965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROUP HEALTH INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0101210R261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473592Medicaid