Healthcare Provider Details

I. General information

NPI: 1881761484
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF THE SOUTHERN FINGER LAKES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 W SENECA ST
ITHACA NY
14850-3326
US

IV. Provider business mailing address

620 W SENECA ST
ITHACA NY
14850-3326
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-1526
  • Fax: 607-216-0039
Mailing address:
  • Phone: 607-273-1526
  • Fax: 607-216-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number5401205R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number5401205R
License Number StateNY

VIII. Authorized Official

Name: PEARL ANDREWS
Title or Position: EXEC. ADMIN
Credential:
Phone: 607-273-1526