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General NPI Number Information
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NPI Number | 1225272610
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Entity Type | Organization
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Legal Business Name | FINGER LAKES MIGRANT HEALTH CARE PROJECT
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Dates
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Enumeration Date | 04/29/2009
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Last Update Date | 04/29/2009
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Provider Practice Location Address
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Address Line | 601 B WEST WASHINGTON ST
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City | GENEVA
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State | NY
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Zip | 14456
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Country | US
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Telephone | 315-531-9102
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Fax | 315-531-9103
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Provider Business Mailing Address
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Address Line | PO BOX 423
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City | PENN YAN
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State | NY
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Zip | 14527-0423
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Country | US
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Telephone | 315-531-9102
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Fax | 315-531-9103
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Authorized Official
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Title or Position | BILLING CLERK
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Name | ROBERTO GARCIA
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Credential |
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Telephone | 315-531-9102
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 36750
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 42795
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 42164
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License Number State | NY
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