1073065561 NPI number — FAMILY SUPPORT IN CENTRAL NEW YORK, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073065561 NPI number — FAMILY SUPPORT IN CENTRAL NEW YORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SUPPORT IN CENTRAL NEW YORK, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073065561
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9582 WHITTAKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLAND PATENT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13354-4343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-794-5799
Provider Business Mailing Address Fax Number:
315-768-3670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
155 MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13421-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-941-2520
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GODLEWSKI
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
FAMILY PEER ADVOCATE
Authorized Official Telephone Number:
315-794-4590

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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