| NAME |
PUTNAM COUNTY |
| STATE |
NEW YORK |
| STREET ADDR. 1 |
1875 ROUTE 6 |
| STREET ADDR. 2 |
PROVIDENT BANK, (2ND FLOOR) |
| CITY |
CARMEL |
| ZIP |
10512-2316 |
| OFFICIAL VA NAME |
PUTNAM COUNTY |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
CARMEL VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1875 ROUTE 6 |
| ST. ADDR. 2 (MAILING) |
PROVIDENT BANK, (2ND FLOOR) |
| CITY (MAILING) |
CARMEL |
| STATE (MAILING) |
NEW YORK |
| ZIP (MAILING) |
10512-2316 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1437100203
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
620GB |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1437100203
-
- CODING SYSTEM: VASTANUM
- ID: 620GB
-
- CODING SYSTEM: CLIA
- ID: 130421703
|
