Basic Information
| Provider Information | |||||||||
| NPI: | 1033114004 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY PLANNING OF SOUTH CENTRAL NEW YORK, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 37 DIETZ ST | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138201882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6074322252 | ||||||||
| FaxNumber: | 6074327206 | ||||||||
| Practice Location | |||||||||
| Address1: | 37 DIETZ ST | ||||||||
| Address2: | |||||||||
| City: | ONEONTA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 138201882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6074322252 | ||||||||
| FaxNumber: | 6074327206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 03/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | MARCUS | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 6074322252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0050X | 3801202R | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 20005690 | 01 | NY | MVP | OTHER | 00020550 | 01 | NY | FHP-GHI HMO | OTHER | 000116717 | 01 | NY | BCBS | OTHER | 0299753 | 01 | NY | FHP-GHI PPO | OTHER | 00468777 | 05 | NY | MEDICAID |