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General NPI Number Information
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NPI Number | 1063572733
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Entity Type | Organization
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Legal Business Name | MARY IMOGENE BASSETT HOSPITAL
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 ATWELL RD
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City | COOPERSTOWN
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State | NY
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Zip | 13326-1301
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Country | US
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Telephone | 607-547-3931
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Fax | 607-547-6325
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Provider Business Mailing Address
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Address Line | 1 ATWELL RD
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City | COOPERSTOWN
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State | NY
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Zip | 13326-1301
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Country | US
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Telephone | 607-547-3931
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Fax | 607-547-6325
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Authorized Official
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Title or Position | CORPORATE VICE PRESIDENT & CFO
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Name | MR. NICHOLAS J NICOLETTA
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Credential |
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Telephone | 607-547-3635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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