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General NPI Number Information
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NPI Number | 1427231919
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Entity Type | Organization
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Legal Business Name | PRACTITIONER SERVICES OF THE SOUTHERN TIER
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 739 LARCHMONT RD
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City | ELMIRA
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State | NY
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Zip | 14905-1216
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Country | US
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Telephone | 607-734-8039
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Fax |
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Provider Business Mailing Address
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Address Line | 739 LARCHMONT RD
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City | ELMIRA
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State | NY
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Zip | 14905-1216
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Country | US
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Telephone | 607-734-8039
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY JOHANNA FOSTER
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Credential | N.P.
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Telephone | 607-734-8039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 331091
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 206255
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License Number State | NY
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