Healthcare Provider Details

I. General information

NPI: 1114979945
Provider Name (Legal Business Name): CLINTON COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MARGARET STREET
PLATTSBURGH NY
12901
US

IV. Provider business mailing address

133 MARGARET ST FL 3
PLATTSBURGH NY
12901-2926
US

V. Phone/Fax

Practice location:
  • Phone: 518-565-4840
  • Fax: 518-565-4717
Mailing address:
  • Phone: 518-565-4840
  • Fax: 518-565-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number09012008
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0901200R
License Number StateNY

VIII. Authorized Official

Name: MARIA CADIEUX
Title or Position: HEALTH FACILITY COMPTROLLER
Credential:
Phone: 518-565-3284