Healthcare Provider Details

I. General information

NPI: 1811385065
Provider Name (Legal Business Name): WYOMING COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 04/23/2015
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

400 N MAIN ST
WARSAW NY
14569-1025
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number277752
License Number StateNY

VIII. Authorized Official

Name: MICHAEL CORCIMIGLIA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 585-786-8940