1154779270 NPI number — CATHERINE E CONWAY DO

Table of content: CATHERINE E CONWAY DO (NPI 1154779270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154779270 NPI number — CATHERINE E CONWAY DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONWAY
Provider First Name:
CATHERINE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

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:
1154779270
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
571 SAINT JOSEPHS BLVD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELMIRA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14901-3230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-271-2050
Provider Business Mailing Address Fax Number:
607-873-1244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 S PORTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATKINS GLEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14891-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-535-7873
Provider Business Practice Location Address Fax Number:
607-535-7469
Provider Enumeration Date:
05/31/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  318840 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: OS0169869 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 05814640 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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