Provider Demographics
NPI:1205005931
Name:EHSOC, INC
Entity type:Organization
Organization Name:EHSOC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BODINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-993-1200
Mailing Address - Street 1:2901 COURT STREET
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-3217
Mailing Address - Country:US
Mailing Address - Phone:315-455-8933
Mailing Address - Fax:315-455-8934
Practice Address - Street 1:2730 ROUTE
Practice Address - Street 2:12B
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-2113
Practice Address - Country:US
Practice Address - Phone:315-824-3453
Practice Address - Fax:315-824-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3797-1332H00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00600977Medicaid
NY56480AMedicaid