1023166691 NPI number — TOMPKINS COUNTY

Table of content: DR. STEPHANIE ANN CORDONNIER MD (NPI 1588230809)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023166691 NPI number — TOMPKINS COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOMPKINS COUNTY
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:
TOMPKINS COUNTY HEALTH DEPARTMENT
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:
1023166691
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 BROWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850-1247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-274-6604
Provider Business Mailing Address Fax Number:
607-274-6620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 BROWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-1247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-274-6604
Provider Business Practice Location Address Fax Number:
607-274-6620
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GRINNELL-CROSBY
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PUBLIC HEALTH ADMINISTRATOR
Authorized Official Telephone Number:
607-274-6677

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00356276 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7744090 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000900819000 . This is a "HEALTH NOW" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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