Provider Demographics
NPI:1154433860
Name:PINNACLE FAMILY PRACTICE
Entity type:Organization
Organization Name:PINNACLE FAMILY PRACTICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-324-1372
Mailing Address - Street 1:7 SENECA ST
Mailing Address - Street 2:C/O INTEGRA MEDICAL SERVICES
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1312
Mailing Address - Country:US
Mailing Address - Phone:607-324-1372
Mailing Address - Fax:607-324-1374
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1933
Practice Address - Country:US
Practice Address - Phone:607-281-1970
Practice Address - Fax:607-281-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0972Medicare PIN