Provider Demographics
NPI:1477784734
Name:ENDICOTT-UNION INC
Entity Type:Organization
Organization Name:ENDICOTT-UNION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:EBERECHUKWU
Authorized Official - Last Name:ORJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-266-8062
Mailing Address - Street 1:248 CHENANGO STREET
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901
Mailing Address - Country:US
Mailing Address - Phone:187-738-0829
Mailing Address - Fax:188-877-3868
Practice Address - Street 1:3677 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5708
Practice Address - Country:US
Practice Address - Phone:187-738-0829
Practice Address - Fax:188-877-3868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
344600000X
NY02960112344600000X
NY5176344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02960112Medicaid