Provider Demographics
NPI:1881761484
Name:PLANNED PARENTHOOD OF THE SOUTHERN FINGER LAKES INC.
Entity type:Organization
Organization Name:PLANNED PARENTHOOD OF THE SOUTHERN FINGER LAKES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-273-1526
Mailing Address - Street 1:620 W SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3326
Mailing Address - Country:US
Mailing Address - Phone:607-273-1526
Mailing Address - Fax:607-216-0039
Practice Address - Street 1:620 W SENECA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3326
Practice Address - Country:US
Practice Address - Phone:607-273-1526
Practice Address - Fax:607-216-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5401205R332900000X, 261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility
No332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00362863Medicaid