Provider Demographics
NPI:1457689119
Name:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC
Entity Type:Organization
Organization Name:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZELAZNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-531-9102
Mailing Address - Street 1:14 MAIDEN LN
Mailing Address - Street 2:PO BOX 423
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1208
Mailing Address - Country:US
Mailing Address - Phone:607-776-3063
Mailing Address - Fax:
Practice Address - Street 1:117 E STEUBEN ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1636
Practice Address - Country:US
Practice Address - Phone:607-776-3063
Practice Address - Fax:315-531-9103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-18
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03176978Medicaid
BA0726Medicare PIN