Provider Demographics
NPI:1760511976
Name:ERIE COUNTY HEALTH - EARLY INTERVENTION PROGRAM
Entity Type:Organization
Organization Name:ERIE COUNTY HEALTH - EARLY INTERVENTION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CHILDERN SPECIAL NEEDS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-858-6161
Mailing Address - Street 1:95 FRANKLIN ST
Mailing Address - Street 2:ROOM 828
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3925
Mailing Address - Country:US
Mailing Address - Phone:716-858-6161
Mailing Address - Fax:716-858-6292
Practice Address - Street 1:95 FRANKLIN ST
Practice Address - Street 2:ROOM 828
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3925
Practice Address - Country:US
Practice Address - Phone:716-858-6161
Practice Address - Fax:716-858-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01952538Medicaid