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Organization

PRACTITIONER SERVICES OF THE SOUTHERN TIER

Active
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Organization

PRACTITIONER SERVICES OF THE SOUTHERN TIER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY JOHANNA FOSTER N.P. (PRESIDENT)
(607) 734-8039
Entity
Organization

Contact information

Practice address
739 LARCHMONT RD, ELMIRA, NY 14905-1216
(607) 734-8039
Mailing address
739 LARCHMONT RD, ELMIRA, NY 14905-1216
(607) 734-8039

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
206255
NY
363L00000X
Nurse Practitioner
331091
NY

Other

Enumeration date
12/07/2007
Last updated
07/01/2008
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