Basic Information
| Provider Information | |||||||||
| NPI: | 1083742720 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROOME COUNTY HEALTH DEPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139052424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077782802 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139052424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077782802 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2007 | ||||||||
| LastUpdateDate: | 03/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | CLAUDIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF PUBLIC HEALTH | ||||||||
| AuthorizedOfficialTelephone: | 6077782802 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | N | Agencies | Public Health or Welfare | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
ID Information
| ID | Type | State | Issuer | Description | 00474608 | 01 | NY | HEALTH DEPT | OTHER |