Basic Information
| Provider Information | |||||||||
| NPI: | 1013969526 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NETANYAHU | ||||||||
| FirstName: | IDDO | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 THE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | HORNELL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073242244 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 411 CANISTEO ST | ||||||||
| Address2: | |||||||||
| City: | HORNELL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148432104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6073248255 | ||||||||
| FaxNumber: | 6073248774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 167192 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00026402001 | 01 | NY | UNIVERA | OTHER | 000921963001 | 01 | NY | HEALTHNOW (BUFFALO) | OTHER | 542067663 | 01 | NY | UNITED HEALTHCARE | OTHER | MDH356 | 01 | NY | PREFERRED CARE | OTHER | 01543131 | 05 | NY | MEDICAID | P010167192 | 01 | NY | BLUE CHOICE (GRIPA) | OTHER | P010167195 | 01 | NY | BCBS | OTHER | P010167192 | 01 | NY | BCBS OF CNY | OTHER |