| St. Joseph's Physician Group | |
|
555 Saint Josephs Blvd Elmira NY 14901-3223 | |
| (607) 733-6541 | |
| (607) 785-9191 |
| Full Name | St. Joseph's Physician Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 555 Saint Josephs Blvd, Elmira, New York |
| Authorized Official Name and Position | Jonathan I. Lawrence (PRESIDENT & CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 6077374100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Joseph's Physician Group 555 Saint Josephs Blvd Elmira NY 14901-3223 Ph: (607) 733-6541 | St. Joseph's Physician Group 555 Saint Josephs Blvd Elmira NY 14901-3223 Ph: (607) 733-6541 |
| NPI Number | 1265580286 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 07/20/2021 |
| Medicare PECOS PAC ID | 7113900754 |
|---|---|
| Medicare Enrollment ID | O20040612000371 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265580286 | NPI | - | NPPES |
| Provider Name | Behrooz Ebrahimi Fard |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1700838158 PECOS PAC ID: 0648217976 Enrollment ID: I20050408000428 |
| Provider Name | Roberta A Grant |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548358203 PECOS PAC ID: 5991806804 Enrollment ID: I20070723000337 |
| Provider Name | Chunying Xu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255404745 PECOS PAC ID: 1557594181 Enrollment ID: I20140505002282 |
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