Organization
SOUTHERN TIER UROLOGY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER W GIST MD (DIRECTOR)
(202) 636-1131
Entity
Organization
Contact information
Practice address
3359 LAURIE BROOK DR, BINGHAMTON, NY 13903-3153
(202) 636-1131
Mailing address
3359 LAURIE BROOK DR, BINGHAMTON, NY 13903-3153
(202) 636-1131
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
234985
NY
2088P0231X
Pediatric Urology Physician
234985
NY
Other
Enumeration date
04/21/2011
Last updated
04/21/2011
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