Basic Information
| Provider Information | |||||||||
| NPI: | 1427019629 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOME COUNTY | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 225 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139052424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077782839 | ||||||||
| FaxNumber: | 6077782838 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139052424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077782839 | ||||||||
| FaxNumber: | 6077782873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 09/30/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | EDWARDS | ||||||||
| AuthorizedOfficialFirstName: | CLAUDIA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PUBLIC HEALTH DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6077782802 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | MS | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | Y | Agencies | Public Health or Welfare |
ID Information
| ID | Type | State | Issuer | Description | 03003927 | 05 | NY | MEDICAID |