Provider Demographics
NPI:1568679520
Name:BINGHAMTON UNIVERSITY HEALTH SERVICES
Entity Type:Organization
Organization Name:BINGHAMTON UNIVERSITY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-777-2221
Mailing Address - Street 1:2064 COUNTY ROAD 32
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:NY
Mailing Address - Zip Code:13778-2338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4400 VESTAL PARKWAY EAST
Practice Address - Street 2:BINGHAMTON UNIVERSITY HEALTH SERVICES
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13902-6000
Practice Address - Country:US
Practice Address - Phone:607-777-2221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179170261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health