Provider Demographics
NPI:1588809636
Name:SENECA COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:SENECA COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PUBLIC HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-539-1920
Mailing Address - Street 1:2465 BONADENT DR. SUITE 3
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165
Mailing Address - Country:US
Mailing Address - Phone:315-539-1920
Mailing Address - Fax:315-539-9493
Practice Address - Street 1:2465 BONADENT DR. SUITE 3
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165
Practice Address - Country:US
Practice Address - Phone:315-539-1920
Practice Address - Fax:315-539-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1239L001251300000X, 251B00000X
NYL1239L001251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0159835OtherEXCELLUS
NY00355399Medicaid
NYP0150035OtherEXCELLUS
NY00355862Medicaid
NY01430955Medicaid
NY00355862Medicaid