1710002167 NPI number — OTSEGO COUNTY CHAPTER, NYSARC, INC.

Table of content: (NPI 1710002167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710002167 NPI number — OTSEGO COUNTY CHAPTER, NYSARC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OTSEGO COUNTY CHAPTER, NYSARC, 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:
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:
1710002167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 490
Provider Second Line Business Mailing Address:
35 ACADEMY STREET
Provider Business Mailing Address City Name:
ONEONTA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13820-0490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-433-8409
Provider Business Mailing Address Fax Number:
607-433-8430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 LOWER RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ONEONTA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13820-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-433-8460
Provider Business Practice Location Address Fax Number:
607-433-8464
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JUDD
Authorized Official First Name:
JOE
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
607-433-8400

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , with the licence number:  6293301 , 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: 00804522 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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