Provider Demographics
NPI:1134277122
Name:GREENE COUNTY PUBLIC HEALTH
Entity type:Organization
Organization Name:GREENE COUNTY PUBLIC HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DSCSN
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:518-719-3600
Mailing Address - Street 1:411 MAIN STREET
Mailing Address - Street 2:3RD FLOOR, SUITE 300
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1366
Mailing Address - Country:US
Mailing Address - Phone:518-719-3600
Mailing Address - Fax:518-719-3779
Practice Address - Street 1:411 MAIN STREET
Practice Address - Street 2:3RD FLOOR, SUITE 300
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1366
Practice Address - Country:US
Practice Address - Phone:518-719-3600
Practice Address - Fax:518-719-3779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREENE COUNTY PUBLIC HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1952600251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430639Medicaid