Provider Demographics
NPI:1407901291
Name:CHAUTAUQUA COUNTY NYS DOH EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:CHAUTAUQUA COUNTY NYS DOH EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHUYLER
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MHA
Authorized Official - Phone:716-753-4797
Mailing Address - Street 1:7 N ERIE ST
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-1090
Mailing Address - Country:US
Mailing Address - Phone:716-753-4792
Mailing Address - Fax:716-753-4794
Practice Address - Street 1:7 N ERIE ST
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-1090
Practice Address - Country:US
Practice Address - Phone:716-753-4792
Practice Address - Fax:716-753-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251B00000X, 252Y00000X
251K00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474800Medicaid
NY02961746Medicaid
NY01440362Medicaid