1821001579 NPI number — CORTLAND COUNTY COUNTY TREASURER

Table of content: (NPI 1821001579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821001579 NPI number — CORTLAND COUNTY COUNTY TREASURER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CORTLAND COUNTY COUNTY TREASURER
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:
CORTLAND COUNTY MENTAL HEALTH
Provider Other Organization Name Type Code:
5
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:
1821001579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 CLAYTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORTLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13045-2501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-758-6100
Provider Business Mailing Address Fax Number:
607-758-6116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 CLAYTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORTLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13045-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-758-6100
Provider Business Practice Location Address Fax Number:
607-758-6116
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MACDOUGALL
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF COMMUNITY SERVICES
Authorized Official Telephone Number:
607-758-6100

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 6952100A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6952100A , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: 238550-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: NYF30339-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 00562890 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02997464 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 041108000114 . This is a "FIDELLAS PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000158890 . This is a "EXCELLUS PROVIDER ID#" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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