Provider Demographics
NPI:1497804215
Name:SENECA CAYUGA COUNTIES CHAPTER NYSARC, INC.
Entity Type:Organization
Organization Name:SENECA CAYUGA COUNTIES CHAPTER NYSARC, INC.
Other - Org Name:SENECA CAYUGA ARC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-856-8124
Mailing Address - Street 1:1083 WATERLOO GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1202
Mailing Address - Country:US
Mailing Address - Phone:315-539-5067
Mailing Address - Fax:315-539-6269
Practice Address - Street 1:1083 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165
Practice Address - Country:US
Practice Address - Phone:315-539-5067
Practice Address - Fax:315-539-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7141304251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1104970557Medicare PIN