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 |
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Speciality | Psychiatry & Neurology |
Location | 1001 E 2nd St, Coudersport, Pennsylvania |
Authorized Official Name and Position | Sampath Neerukonda (OWNER) |
Authorized Official Contact | 6073243580 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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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 |
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Provider Enumeration Date | 08/12/2008 |
Last Update Date | 04/21/2009 |
Medicare PECOS PAC ID | 3072536853 |
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Medicare Enrollment ID | O20081030000402 |
Identifier | Type | State | Issuer |
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1568618353 | NPI | - | NPPES |
001713173 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084P0800X | Psychiatry & Neurology - Psychiatry | MD052162L (Pennsylvania) | Primary |
Provider Name | Sampath K Neerukonda |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1801842919 PECOS PAC ID: 6901792126 Enrollment ID: I20040225000351 |
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