1205277886 NPI number — ONONDAGA COUNTY DEPARTMENT OF MENTAL HEALTH

Table of content: (NPI 1205277886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205277886 NPI number — ONONDAGA COUNTY DEPARTMENT OF MENTAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONONDAGA COUNTY DEPARTMENT OF MENTAL HEALTH
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:
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:
1205277886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 MONTGOMERY ST
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:
13202-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-435-3355
Provider Business Mailing Address Fax Number:
315-435-3279

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULLY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13159-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-435-7706
Provider Business Practice Location Address Fax Number:
315-435-7715
Provider Enumeration Date:
07/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
C
Authorized Official Title or Position:
COMMISSIONER
Authorized Official Telephone Number:
315-435-3355

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 335184 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00565031 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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