Healthcare Provider Details

I. General information

NPI: 1992855225
Provider Name (Legal Business Name): ITHACA COLLEGE STUDENT HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 DANBY RD HAMMOND HEALTH, ITHACA COLLEGE
ITHACA NY
14850-7000
US

IV. Provider business mailing address

953 DANBY RD HAMMOND HEALTH, ITHACA COLLEGE
ITHACA NY
14850-7000
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-3177
  • Fax: 607-274-1844
Mailing address:
  • Phone: 607-274-3177
  • Fax: 607-274-1844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN ELDREDGE
Title or Position: MGR. HEALTH CENTER OPERATIONS
Credential:
Phone: 607-274-3205