Healthcare Provider Details

I. General information

NPI: 1528119666
Provider Name (Legal Business Name): TIOGA COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 11/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 RTE 38
OWEGO NY
13827-3209
US

IV. Provider business mailing address

1062 RTE 38
OWEGO NY
13827-3209
US

V. Phone/Fax

Practice location:
  • Phone: 607-687-8600
  • Fax: 607-687-2916
Mailing address:
  • Phone: 607-687-8600
  • Fax: 607-687-2916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number5324200R
License Number StateNY

VIII. Authorized Official

Name: MS. JANICE MARIE YURICEK
Title or Position: ADMINISTRATIVE ACCOUNTING SUPERVISO
Credential:
Phone: 607-687-8573