Organization
EMBLEMHEALTH MEDICAL AND DENTAL SERVICES INC.
Active
Other names
GHI Family Dental Practice/OEHC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN E BENN (MANAGER)
(518) 869-1717
Entity
Organization
Contact information
Practice address
1873 WESTERN AVE, SUITE 200, ALBANY, NY 12203-5028
(518) 869-1044
(518) 869-1965
Mailing address
1873 WESTERN AVE, SUITE 200, ALBANY, NY 12203-5028
(518) 869-1044
(518) 869-1965
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
0101222R
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101222R
FACILITY LICENSE
NY
Enumeration date
04/18/2011
Last updated
07/30/2012
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