Healthcare Provider Details

I. General information

NPI: 1376510081
Provider Name (Legal Business Name): TOWN OF MT. MORRIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 MAIN ST
MOUNT MORRIS NY
14510-1239
US

IV. Provider business mailing address

5530 SHERIDAN DR SUITE 3B
WILLIAMSVILLE NY
14221-3730
US

V. Phone/Fax

Practice location:
  • Phone: 585-658-2730
  • Fax: 585-658-3021
Mailing address:
  • Phone: 716-204-3350
  • Fax: 716-247-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2519
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: CHARLES DIPASQUALE
Title or Position: TOWN SUPERVISOR
Credential:
Phone: 585-658-2730