Provider Demographics
NPI:1013049873
Name:HERKIMER COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:HERKIMER COUNTY PUBLIC HEALTH
Other - Org Name:EARLY INTERVENTION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-867-1176
Mailing Address - Street 1:301 N WASHINGTON ST
Mailing Address - Street 2:SUITE 2355
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1216
Mailing Address - Country:US
Mailing Address - Phone:315-867-1442
Mailing Address - Fax:315-867-1431
Practice Address - Street 1:301 N WASHINGTON ST
Practice Address - Street 2:SUITE 2355
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1216
Practice Address - Country:US
Practice Address - Phone:315-867-1442
Practice Address - Fax:315-867-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473712Medicaid