Provider Demographics
NPI:1942660105
Name:WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-465-4771
Mailing Address - Street 1:920 LARK DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1300
Mailing Address - Country:US
Mailing Address - Phone:518-465-4771
Mailing Address - Fax:518-320-3022
Practice Address - Street 1:10 DEWITT STREET
Practice Address - Street 2:WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1300
Practice Address - Country:US
Practice Address - Phone:518-465-4771
Practice Address - Fax:518-320-3022
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WHITNEY M. YOUNG JR. HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331807Medicaid