Provider Demographics
NPI:1164705224
Name:CLINICAL CAMPUS MEDICAL GROUP
Entity Type:Organization
Organization Name:CLINICAL CAMPUS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LENORE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MS
Authorized Official - Phone:607-772-3535
Mailing Address - Street 1:425 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1735
Mailing Address - Country:US
Mailing Address - Phone:607-772-3535
Mailing Address - Fax:607-772-3536
Practice Address - Street 1:425 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1735
Practice Address - Country:US
Practice Address - Phone:607-772-3535
Practice Address - Fax:607-772-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty