Provider Demographics
NPI:1407060759
Name:WYOMING COUNTY
Entity Type:Organization
Organization Name:WYOMING COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORCIMIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-786-8940
Mailing Address - Street 1:143 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569-1100
Mailing Address - Country:US
Mailing Address - Phone:585-786-8940
Mailing Address - Fax:585-786-1222
Practice Address - Street 1:400 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569-1025
Practice Address - Country:US
Practice Address - Phone:585-786-8940
Practice Address - Fax:585-786-1222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYOMING COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03372245Medicaid
NYFA0944OtherPREFERRED CARE
NY70102AMedicaid
NY00040514704OtherUNIVERA
NY000525907002OtherBLUE CROSS