Provider Demographics
NPI:1114114808
Name:STAMFORD FAMILY PRACTICE
Entity Type:Organization
Organization Name:STAMFORD FAMILY PRACTICE
Other - Org Name:AO FOX MEMORIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-431-5900
Mailing Address - Street 1:32 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:NY
Mailing Address - Zip Code:12167-1145
Mailing Address - Country:US
Mailing Address - Phone:607-652-2000
Mailing Address - Fax:
Practice Address - Street 1:1 NORTON AVE
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2629
Practice Address - Country:US
Practice Address - Phone:607-431-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279098Medicaid
NY00279098Medicaid