Provider Demographics
NPI:1447259387
Name:EMPOWERMENT BY DESIGN
Entity type:Organization
Organization Name:EMPOWERMENT BY DESIGN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:607-351-1655
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851-0506
Mailing Address - Country:US
Mailing Address - Phone:607-351-1655
Mailing Address - Fax:607-273-5363
Practice Address - Street 1:117 N SUNSET DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1459
Practice Address - Country:US
Practice Address - Phone:607-351-1655
Practice Address - Fax:607-273-5363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0235Medicare PIN
NYQ21290Medicare UPIN
NYRA2711Medicare PIN
NYRA2710Medicare PIN
NYQ21280Medicare UPIN