| Nids Coalition Northern Chapter | |
| 
					103 S Main St Black River NY 13612-2101  | |
| (315) 773-5405 | |
| (315) 773-5378 | 
| Full Name | Nids Coalition Northern Chapter | 
|---|---|
| Speciality | General Practice | 
| Location | 103 S Main St, Black River, New York | 
| Authorized Official Name and Position | Katherine Robertson (DIRECTOR) | 
| Authorized Official Contact | 3157735405 | 
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. | 
| Mailing Address | Practice Location Address | 
|---|---|
| Nids Coalition Northern Chapter 103 S Main St Black River NY 13612-2101 Ph: (315) 773-5405  | Nids Coalition Northern Chapter 103 S Main St Black River NY 13612-2101 Ph: (315) 773-5405  | 
| NPI Number | 1114178001 | 
|---|---|
| Provider Enumeration Date | 10/09/2008 | 
| Last Update Date | 10/09/2008 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1114178001 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |