Basic Information
| Provider Information | |||||||||
| NPI: | 1629028089 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTHTOWNS ORTHOPEDICS, PC | ||||||||
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| 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: | 8750 TRANSIT RD | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | EAST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140512610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166361470 | ||||||||
| FaxNumber: | 7166361423 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | FARWELL | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7166361470 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | CF7263 | 01 | NY | MEDICARE RAILROAD PIN | OTHER |