Healthcare Provider Details

I. General information

NPI: 1407901291
Provider Name (Legal Business Name): CHAUTAUQUA COUNTY NYS DOH EARLY INTERVENTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 N ERIE ST
MAYVILLE NY
14757-1090
US

IV. Provider business mailing address

7 N ERIE ST
MAYVILLE NY
14757-1090
US

V. Phone/Fax

Practice location:
  • Phone: 716-753-4792
  • Fax: 716-753-4794
Mailing address:
  • Phone: 716-753-4792
  • Fax: 716-753-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. CHRISTINE SCHUYLER
Title or Position: PUBLIC HEALTH DIRECTOR
Credential: BSN, MHA
Phone: 716-753-4797