Provider Demographics
NPI:1922130335
Name:SOUTHERN TIER AIDS PROGRAM, INC.
Entity Type:Organization
Organization Name:SOUTHERN TIER AIDS PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-798-1706
Mailing Address - Street 1:122 BALDWIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2148
Mailing Address - Country:US
Mailing Address - Phone:607-798-1706
Mailing Address - Fax:607-798-1977
Practice Address - Street 1:122 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2148
Practice Address - Country:US
Practice Address - Phone:607-798-1706
Practice Address - Fax:607-798-1977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01681130Medicaid