Provider Demographics
NPI:1396882684
Name:SCHENECTADY COUNTY PUBLIC HEALTH SERVICES CLINIC
Entity type:Organization
Organization Name:SCHENECTADY COUNTY PUBLIC HEALTH SERVICES CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COMMISSIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CALLNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-386-2810
Mailing Address - Street 1:1007 NOTT TERRACE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308
Mailing Address - Country:US
Mailing Address - Phone:518-386-2824
Mailing Address - Fax:518-382-5418
Practice Address - Street 1:600 FRANKLIN ST
Practice Address - Street 2:SUITE 104 106
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305
Practice Address - Country:US
Practice Address - Phone:518-346-2187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4601207R261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01218726Medicaid
54586BMedicare ID - Type Unspecified