Provider Demographics
NPI:1841357050
Name:ELMIRA PSYCHIATRIC CENTER
Entity type:Organization
Organization Name:ELMIRA PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:GIARRUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-473-3598
Mailing Address - Street 1:44 HOLLAND AVE
Mailing Address - Street 2:ATTN: SOFG/MEDICARE D
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12229-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:518-486-4303
Practice Address - Street 1:100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2849
Practice Address - Country:US
Practice Address - Phone:607-737-4739
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
NY3336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3329465Medicare ID - Type Unspecified