Basic Information
| Provider Information | |||||||||
| NPI: | 1326043464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINTERBERGER | ||||||||
| FirstName: | JOSEPH | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 STEUBEN STREET | ||||||||
| Address2: | |||||||||
| City: | MONTOUR FALLSA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075357121 | ||||||||
| FaxNumber: | 6072438483 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MILLARD ST | ||||||||
| Address2: | |||||||||
| City: | DUNDEE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148371024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072438311 | ||||||||
| FaxNumber: | 6072438483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 01/27/2014 | ||||||||
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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 | 207Q00000X | 196510 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01599146 | 05 | NY | MEDICAID | P010196510 | 01 | NY | EXCELLUS BCBS | OTHER | 5997157 | 01 | NY | GHI | OTHER | 000914169002 | 01 | NY | HEALTHNOW | OTHER | P41754 | 01 | NY | GHIFHP | OTHER |