Provider Demographics
NPI:1023567625
Name:HARTWICK COLLEGE PERRELLA HEALTH CENTER
Entity Type:Organization
Organization Name:HARTWICK COLLEGE PERRELLA HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:607-431-4120
Mailing Address - Street 1:1 HARTWICK DR
Mailing Address - Street 2:PERRELLA HEALTH CENTER
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-4000
Mailing Address - Country:US
Mailing Address - Phone:607-431-4120
Mailing Address - Fax:607-431-4124
Practice Address - Street 1:1 HARTWICK DR
Practice Address - Street 2:PERRELLA HEALTH CENTER
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-4000
Practice Address - Country:US
Practice Address - Phone:607-431-4120
Practice Address - Fax:607-431-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF336903261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health