Provider Demographics
NPI:1265625685
Name:AIDS COUNCIL OF NORTHEASTERN NEW YORK
Entity type:Organization
Organization Name:AIDS COUNCIL OF NORTHEASTERN NEW YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-434-4686
Mailing Address - Street 1:927 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1306
Mailing Address - Country:US
Mailing Address - Phone:518-434-4686
Mailing Address - Fax:518-427-8184
Practice Address - Street 1:927 BROADWAY
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12207-1306
Practice Address - Country:US
Practice Address - Phone:518-434-4686
Practice Address - Fax:518-427-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04129318Medicaid