Healthcare Provider Details

I. General information

NPI: 1801048764
Provider Name (Legal Business Name): VILLAGE OF WEST WINFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MAIN STREET WEST
WEST WINFIELD NY
13491-2900
US

IV. Provider business mailing address

PO BOX 290184
WETHERSFIELD CT
06129-0184
US

V. Phone/Fax

Practice location:
  • Phone: 315-822-6223
  • Fax: 315-822-0020
Mailing address:
  • Phone: 800-452-8191
  • Fax: 860-563-3403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number2118
License Number StateNY

VIII. Authorized Official

Name: MRS. MARY T GENTILE
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 800-452-8181