1205005931 NPI number — EHSOC, INC

Table of content: (NPI 1205005931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205005931 NPI number — EHSOC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EHSOC, 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:
6
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:
1205005931
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2901 COURT STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13208-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-455-8933
Provider Business Mailing Address Fax Number:
315-455-8934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2730 ROUTE
Provider Second Line Business Practice Location Address:
12B
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13346-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-824-3453
Provider Business Practice Location Address Fax Number:
315-824-4301
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BODINE
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
716-993-1200

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  3797-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00600977 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 56480A , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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