Provider Demographics
NPI:1194881110
Name:OWEGO
Entity type:Organization
Organization Name:OWEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PUPIL PERSONNEL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:COMERFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:607-687-6226
Mailing Address - Street 1:5 SHELDON GUILE BLVD
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1062
Mailing Address - Country:US
Mailing Address - Phone:607-687-6226
Mailing Address - Fax:607-687-6313
Practice Address - Street 1:5 SHELDON GUILE BLVD
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1062
Practice Address - Country:US
Practice Address - Phone:607-687-6226
Practice Address - Fax:607-687-6313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01379588Medicaid