Basic Information
| Provider Information | |||||||||
| NPI: | 1205198579 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BROOME COUNTY HEALTH DEPT. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 225 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139052474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077782844 | ||||||||
| FaxNumber: | 6077782864 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139052474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077782844 | ||||||||
| FaxNumber: | 6077782864 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2012 | ||||||||
| LastUpdateDate: | 06/13/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | DEUEL-LEWIS | ||||||||
| AuthorizedOfficialFirstName: | BOBBIE | ||||||||
| AuthorizedOfficialMiddleName: | JO | ||||||||
| AuthorizedOfficialTitleorPosition: | EARLY INTERVENTION SERVICE COORDINA | ||||||||
| AuthorizedOfficialTelephone: | 6077782844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.