Basic Information
| Provider Information | |||||||||
| NPI: | 1770927451 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELMIRA PSYCHIATRIC CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 WASHINGTON STREET | ||||||||
| Address2: | ELMIRA PSYCHIATRIC CENTER | ||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077393581 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 WASHINGTON STREET | ||||||||
| Address2: | ELMIRA PSYCHIATRIC CENTER | ||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077393581 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 04/24/2013 | ||||||||
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| AuthorizedOfficialLastName: | STEPHANIE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OR OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 6077074700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NYSOMH | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | ADMINISTRATOR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | NY | Y | Hospitals | Psychiatric Hospital |
No ID Information.