Organization
OUR LADY OF LOURDES MEMORIAL HOSPITAL INC
Active
Other names
Lourdes Center for Oral Health
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHRISTOPHER JOHN BARON (DIRECTOR OF PFS)
(607) 584-5459
Entity
Organization
Contact information
Practice address
219 FRONT ST, BINGHAMTON, NY 13905-2424
(607) 584-4545
Mailing address
169 RIVERSIDE DR, BINGHAMTON, NY 13905-4246
(607) 584-5459
(607) 584-5482
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
0301001H
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00337664
—
NY
01
—
0301001H
LICENSE NUMBER
NY
Enumeration date
05/29/2007
Last updated
05/29/2008
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