Provider Demographics
NPI:1669568465
Name:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.
Entity type:Organization
Organization Name:FINGER LAKES MIGRANT HEALTH CARE PROJECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ZELAZNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-531-9102
Mailing Address - Street 1:14 MAIDEN LN
Mailing Address - Street 2:PO BOX 423
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1208
Mailing Address - Country:US
Mailing Address - Phone:315-531-9102
Mailing Address - Fax:315-531-9103
Practice Address - Street 1:6341 RIDGE RD
Practice Address - Street 2:
Practice Address - City:SODUS
Practice Address - State:NY
Practice Address - Zip Code:14551-9743
Practice Address - Country:US
Practice Address - Phone:315-531-9102
Practice Address - Fax:315-531-9103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02619881Medicaid
NY02619881Medicaid