Provider Demographics
NPI:1265508253
Name:VILLAGE OF DANNEMORA
Entity Type:Organization
Organization Name:VILLAGE OF DANNEMORA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PATNODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-293-8290
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-0186
Mailing Address - Country:US
Mailing Address - Phone:585-768-2192
Mailing Address - Fax:585-768-7323
Practice Address - Street 1:121 EMMONS ST.
Practice Address - Street 2:
Practice Address - City:DANNEMORA
Practice Address - State:NY
Practice Address - Zip Code:12929
Practice Address - Country:US
Practice Address - Phone:518-293-8290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY09143416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0631Medicare ID - Type Unspecified