Healthcare Provider Details

I. General information

NPI: 1407060759
Provider Name (Legal Business Name): WYOMING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569-1025
US

IV. Provider business mailing address

143 N MAIN ST
WARSAW NY
14569-1100
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-8940
  • Fax: 585-786-1222
Mailing address:
  • Phone: 585-786-8940
  • Fax: 585-786-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL A. CORCIMIGLIA
Title or Position: COO
Credential:
Phone: 585-786-8940