Provider Demographics
NPI:1285761759
Name:SCHUYLER COUNTY
Entity type:Organization
Organization Name:SCHUYLER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROETS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,MS
Authorized Official - Phone:607-535-8140
Mailing Address - Street 1:106 S PERRY ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WATKINS GLEN
Mailing Address - State:NY
Mailing Address - Zip Code:14891-1615
Mailing Address - Country:US
Mailing Address - Phone:607-535-8140
Mailing Address - Fax:607-535-8157
Practice Address - Street 1:106 S PERRY ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WATKINS GLEN
Practice Address - State:NY
Practice Address - Zip Code:14891-1615
Practice Address - Country:US
Practice Address - Phone:607-535-8140
Practice Address - Fax:607-535-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430946Medicaid