Healthcare Provider Details

I. General information

NPI: 1134127251
Provider Name (Legal Business Name): EARLY INTERVENTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 CENTRAL AVE
CORTLAND NY
13045-2746
US

IV. Provider business mailing address

60 CENTRAL AVE
CORTLAND NY
13045-2746
US

V. Phone/Fax

Practice location:
  • Phone: 607-753-5135
  • Fax: 607-753-5209
Mailing address:
  • Phone: 607-753-5135
  • Fax: 607-753-5209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE FEUERHERM
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: RN MSN
Phone: 607-753-5135