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General NPI Number Information
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NPI Number | 1619942117
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Entity Type | Organization
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Legal Business Name | ST ELIZABETH MEDICAL CENTER
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Dates
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Enumeration Date | 02/20/2006
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 14 FOERY DR
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City | UTICA
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State | NY
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Zip | 13501-6236
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Country | US
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Telephone | 315-797-9770
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Fax | 315-732-7216
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Provider Business Mailing Address
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Address Line | 14 FOERY DR
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City | UTICA
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State | NY
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Zip | 13501-6236
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Country | US
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Telephone | 315-797-9770
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Fax | 315-732-7216
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Authorized Official
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Title or Position | MANAGER
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Name | ANN BOERGER PIERSMA
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Credential |
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Telephone | 315-797-9770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 3202605
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License Number State | NY
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