Provider Demographics
NPI:1548484355
Name:CORTLAND COUNTY
Entity type:Organization
Organization Name:CORTLAND COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAILOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-753-5036
Mailing Address - Street 1:60 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-2795
Mailing Address - Country:US
Mailing Address - Phone:607-753-5036
Mailing Address - Fax:607-753-5136
Practice Address - Street 1:60 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2795
Practice Address - Country:US
Practice Address - Phone:607-753-5036
Practice Address - Fax:607-753-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01430515Medicaid