| NAME |
FONDA CBOC |
| STATE |
NEW YORK |
| STREET ADDR. 1 |
2623 STATE HIGHWAY 30A |
| CITY |
FONDA |
| ZIP |
12068-5961 |
| OFFICIAL VA NAME |
FONDA CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
FONDA VA CLINIC |
| ST. ADDR. 1 (MAILING) |
2623 STATE HIGHWAY 30A |
| CITY (MAILING) |
FONDA |
| STATE (MAILING) |
NEW YORK |
| ZIP (MAILING) |
12068-5961 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1013960350
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
528G6 |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1013960350
-
- CODING SYSTEM: VASTANUM
- ID: 528G6
-
- CODING SYSTEM: CLIA
- ID: 33D1097470
|
