Basic Information
Provider Information | |||||||||
NPI: | 1588976096 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NORTHTOWNS ORTHOPEDICS, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8750 TRANSIT RD | ||||||||
Address2: | SUITE 105 | ||||||||
City: | EAST AMHERST | ||||||||
State: | NY | ||||||||
PostalCode: | 140512610 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7166361470 | ||||||||
FaxNumber: | 7166361423 | ||||||||
Practice Location | |||||||||
Address1: | 6133 ROUTE 219 S | ||||||||
Address2: | SUITE 1001 | ||||||||
City: | ELLICOTTVILLE | ||||||||
State: | NY | ||||||||
PostalCode: | 147319613 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7166361470 | ||||||||
FaxNumber: | 7166361423 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/13/2010 | ||||||||
LastUpdateDate: | 08/10/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DOUGLAS | ||||||||
AuthorizedOfficialFirstName: | DONALD | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | M.D./MANAGING PARTNER | ||||||||
AuthorizedOfficialTelephone: | 7166361470 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |   |
No ID Information.