Provider Demographics
NPI:1053089516
Name:TRI COUNTY FAMILY HEALTH AND ADULT HEALTH NP SERVICES
Entity Type:Organization
Organization Name:TRI COUNTY FAMILY HEALTH AND ADULT HEALTH NP SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MS
Authorized Official - Phone:607-208-4284
Mailing Address - Street 1:204 COUNTY ROAD 39
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:NY
Mailing Address - Zip Code:13730-2252
Mailing Address - Country:US
Mailing Address - Phone:607-208-4284
Mailing Address - Fax:607-900-3336
Practice Address - Street 1:204 COUNTY ROAD 39
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:NY
Practice Address - Zip Code:13730-2252
Practice Address - Country:US
Practice Address - Phone:607-208-4284
Practice Address - Fax:607-900-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty