1467555243 NPI number — OTSEGO COUNTY COMMUNITY SERVICES

Table of content: (NPI 1467555243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467555243 NPI number — OTSEGO COUNTY COMMUNITY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OTSEGO COUNTY COMMUNITY SERVICES
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:
1467555243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
242 MAIN ST
Provider Second Line Business Mailing Address:
SECOND FLOOR
Provider Business Mailing Address City Name:
ONEONTA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13820-2527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-431-1030
Provider Business Mailing Address Fax Number:
607-431-1033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 COUNTY HIGHWAY 33W
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
COOPERSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13326-4953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-547-1600
Provider Business Practice Location Address Fax Number:
607-547-1607
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR OF COMMUNITY SERVICES
Authorized Official Telephone Number:
607-433-2343

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  061110917 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00583582 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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