Healthcare Provider Details

I. General information

NPI: 1467448274
Provider Name (Legal Business Name): ESSEX COUNTY TREASURER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 PARK ST
ELIZABETHTOWN NY
12932
US

IV. Provider business mailing address

PO BOX 127
ELIZABETHTOWN NY
12932-0127
US

V. Phone/Fax

Practice location:
  • Phone: 518-873-3570
  • Fax: 518-873-6764
Mailing address:
  • Phone: 518-873-3582
  • Fax: 518-873-6764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number152 1300N
License Number StateNY

VIII. Authorized Official

Name: MR. DEBORAH LB GIFFORD
Title or Position: ADMINISTRATOR
Credential:
Phone: 518-873-3582