1104165349 NPI number — FINGER LAKES MIGRANT HEALTH CARE PROJECT, 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 1104165349 NPI number — FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FINGER LAKES MIGRANT HEALTH CARE PROJECT, 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:
OVID COMMUNITY HEALTH
Provider Other Organization Name Type Code:
3
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:
1104165349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 MAIDEN LN
Provider Second Line Business Mailing Address:
PO BOX 423
Provider Business Mailing Address City Name:
PENN YAN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14527-1208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-531-9102
Provider Business Mailing Address Fax Number:
315-531-9103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7150 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-531-9102
Provider Business Practice Location Address Fax Number:
315-531-9103
Provider Enumeration Date:
02/07/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ZELAZNY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
315-531-9102

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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