Provider Demographics
NPI:1639322704
Name:ESSEX COUNTY PUBLIC HEALTH NURSING SERVICE
Entity Type:Organization
Organization Name:ESSEX COUNTY PUBLIC HEALTH NURSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVISON
Authorized Official - Suffix:
Authorized Official - Credentials:MSHSA, PTA
Authorized Official - Phone:518-873-3515
Mailing Address - Street 1:132 WATER STREET
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0217
Mailing Address - Country:US
Mailing Address - Phone:518-873-3500
Mailing Address - Fax:518-873-3539
Practice Address - Street 1:132 WATER STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0217
Practice Address - Country:US
Practice Address - Phone:518-873-3500
Practice Address - Fax:518-873-3539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473487Medicaid
55650BMedicare PIN