Provider Demographics
NPI:1588684088
Name:SEAWAY HEALTHCARE OF OGDENSBURG
Entity Type:Organization
Organization Name:SEAWAY HEALTHCARE OF OGDENSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DITTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-393-6749
Mailing Address - Street 1:813 STATE ST
Mailing Address - Street 2:P.O. BOX 1543
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-3362
Mailing Address - Country:US
Mailing Address - Phone:315-393-6749
Mailing Address - Fax:315-394-1417
Practice Address - Street 1:813 STATE ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3362
Practice Address - Country:US
Practice Address - Phone:315-393-6749
Practice Address - Fax:315-394-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY54153AMedicare ID - Type Unspecified