Provider Demographics
NPI:1457577868
Name:MONTGOMERY COUNTY PUBLIC HEALTH DEPT.
Entity type:Organization
Organization Name:MONTGOMERY COUNTY PUBLIC HEALTH DEPT.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONBOY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:518-853-3531
Mailing Address - Street 1:20 PARK ST
Mailing Address - Street 2:
Mailing Address - City:FONDA
Mailing Address - State:NY
Mailing Address - Zip Code:12068-4830
Mailing Address - Country:US
Mailing Address - Phone:518-853-3531
Mailing Address - Fax:518-853-8218
Practice Address - Street 1:20 PARK ST
Practice Address - Street 2:
Practice Address - City:FONDA
Practice Address - State:NY
Practice Address - Zip Code:12068-4830
Practice Address - Country:US
Practice Address - Phone:518-853-3531
Practice Address - Fax:518-853-8218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473556Medicaid