Healthcare Provider Details

I. General information

NPI: 1376671974
Provider Name (Legal Business Name): TIOGA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 STATE RTE 38
OWEGO NY
13827
US

IV. Provider business mailing address

1062 STATE RTE 38 P.O. BOX 120
OWEGO NY
13827
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-8632
  • Fax:
Mailing address:
  • Phone: 607-687-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number5324200R
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number5324200R
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateNY

VIII. Authorized Official

Name: MR. DENIS MCCANN
Title or Position: DIRECTOR OF ADMINISTRATIVE SERVICES
Credential:
Phone: 607-687-8604