Provider Demographics
NPI:1659759587
Name:WYOMING COUNTY
Entity Type:Organization
Organization Name:WYOMING COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORCIMIGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MSL
Authorized Official - Phone:585-786-8940
Mailing Address - Street 1:400 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569
Mailing Address - Country:US
Mailing Address - Phone:585-786-8940
Mailing Address - Fax:585-786-1222
Practice Address - Street 1:400 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:NY
Practice Address - Zip Code:14569
Practice Address - Country:US
Practice Address - Phone:585-786-8940
Practice Address - Fax:585-786-1222
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WYOMING COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255096207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty