| Western New York Med-psych Pllc | |
|
1001 E 2nd St Coudersport PA 16915-8161 | |
| (800) 324-8820 | |
| Not Available |
| Full Name | Western New York Med-psych Pllc |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 1001 E 2nd St, Coudersport, Pennsylvania |
| Authorized Official Name and Position | Sampath Neerukonda (OWNER) |
| Authorized Official Contact | 6073243580 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Western New York Med-psych Pllc 111 E 14th St Elmira Heights NY 14903-1303 Ph: (607) 734-9539 | Western New York Med-psych Pllc 1001 E 2nd St Coudersport PA 16915-8161 Ph: (800) 324-8820 |
| NPI Number | 1568618353 |
|---|---|
| Provider Enumeration Date | 08/12/2008 |
| Last Update Date | 04/21/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568618353 | NPI | - | NPPES |
| 001713173 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD052162L (Pennsylvania) | Primary |
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