=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669613840
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ARC OF DELAWARE COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2009
-----------------------------------------------------
Last Update Date | 03/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34570 STATE HIGHWAY 1 SUITE 1
-----------------------------------------------------
City | WALTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13856-9711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-865-6783
-----------------------------------------------------
Fax | 607-865-6932
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34570 STATE HIGHWAY 1 SUITE 1
-----------------------------------------------------
City | WALTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13856-9711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-865-7126
-----------------------------------------------------
Fax | 607-865-7129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. GEORGE SUESS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 607-865-7126
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------