1962657569 NPI number — CITY OF WATERVLIET

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962657569 NPI number — CITY OF WATERVLIET

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WATERVLIET
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:
1962657569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8610 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14221-7455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-204-3350
Provider Business Mailing Address Fax Number:
716-247-5274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 13 STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERVLIET
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12189-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-270-3830
Provider Business Practice Location Address Fax Number:
518-270-5273
Provider Enumeration Date:
11/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AUSTIN
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
518-270-3800

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  NY , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P01007723 . This is a "RAILROAD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03093056 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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