Basic Information
| Provider Information | |||||||||
| NPI: | 1639105018 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN TIER ASSOCIATES IN PODIATRIC MEDICINE & SURGERY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 RIVERSIDE DR | ||||||||
| Address2: | SUITE M08 | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077237454 | ||||||||
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| Practice Location | |||||||||
| Address1: | 161 RIVERSIDE DR | ||||||||
| Address2: | SUITE M08 | ||||||||
| City: | BINGHAMTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 139054176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077237454 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | PODIATRIST PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 6077237454 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 0024301 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.