Healthcare Provider Details

I. General information

NPI: 1912973827
Provider Name (Legal Business Name): VILLAGE OF BROCKPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 STATE ST
BROCKPORT NY
14420-1921
US

IV. Provider business mailing address

PO BOX 186
LE ROY NY
14482-0186
US

V. Phone/Fax

Practice location:
  • Phone: 585-768-2192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2717
License Number StateNY

VIII. Authorized Official

Name: DAN RAY
Title or Position: ADMINISTRATOR
Credential:
Phone: 585-768-2192