Provider Demographics
NPI:1942455126
Name:FINGER LAKES EVALUATION GROUP
Entity Type:Organization
Organization Name:FINGER LAKES EVALUATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:315-729-1901
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-0477
Mailing Address - Country:US
Mailing Address - Phone:315-729-1901
Mailing Address - Fax:315-568-2570
Practice Address - Street 1:27 TALL OAKS DR
Practice Address - Street 2:
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-1133
Practice Address - Country:US
Practice Address - Phone:315-729-1901
Practice Address - Fax:315-568-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008177252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency