Healthcare Provider Details

I. General information

NPI: 1144609504
Provider Name (Legal Business Name): TOWN OF COHOCTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MAIN STREET
ATLANTA NY
14808-9726
US

IV. Provider business mailing address

5530 SHERIDAN DR SUITE 3B
WILLIAMSVILLE NY
14221-3730
US

V. Phone/Fax

Practice location:
  • Phone: 585-534-5100
  • Fax:
Mailing address:
  • Phone: 716-204-3350
  • Fax: 716-634-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number32558
License Number StateNY

VIII. Authorized Official

Name: WILLIAM ZIGENFUS
Title or Position: TOWN SUPERVISOR
Credential:
Phone: 585-534-5100