Healthcare Provider Details

I. General information

NPI: 1659902971
Provider Name (Legal Business Name): COUNTY OF STEUBEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 E PULTENEY SQ
BATH NY
14810-1510
US

IV. Provider business mailing address

3 E PULTENEY SQ
BATH NY
14810-1510
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-2438
  • Fax: 607-664-2166
Mailing address:
  • Phone: 607-664-2438
  • Fax: 607-664-2166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TERRI DRAKE
Title or Position: ACCOUNTANT
Credential:
Phone: 607-664-2438