Basic Information
| Provider Information | |||||||||
| NPI: | 1790319077 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PINNACLE ORGANIZATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 519 | ||||||||
| Address2: | |||||||||
| City: | WATERTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136010519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157823941 | ||||||||
| FaxNumber: | 3157823816 | ||||||||
| Practice Location | |||||||||
| Address1: | 216 COUNTY ROUTE 64 | ||||||||
| Address2: | |||||||||
| City: | MEXICO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131143229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3159630864 | ||||||||
| FaxNumber: | 3159631456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2020 | ||||||||
| LastUpdateDate: | 02/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | DUPRE | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ACCOUNTS PAYABLE | ||||||||
| AuthorizedOfficialTelephone: | 3157823941 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No ID Information.