Provider Demographics
NPI:1528054194
Name:COUNTY OF CHEMUNG
Entity type:Organization
Organization Name:COUNTY OF CHEMUNG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZETTI
Authorized Official - Suffix:III
Authorized Official - Credentials:MPH
Authorized Official - Phone:607-737-2868
Mailing Address - Street 1:103 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14902-0588
Mailing Address - Country:US
Mailing Address - Phone:607-737-2001
Mailing Address - Fax:607-737-2016
Practice Address - Street 1:103 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14902-0588
Practice Address - Country:US
Practice Address - Phone:607-737-2001
Practice Address - Fax:607-737-2016
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF CHEMUNG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-20
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0701600251E00000X
NY0701901L251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00372743Medicaid
NY00719773Medicaid
NY00671081Medicaid
NY00671081Medicaid