Organization
WESTERN NEW YORK MED-PSYCH PLLC
Active
Parent organization
WESTERN NEW YORK MED-PSYCH PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN NEW YORK MED-PSYCH PLLC
Authorized official
SAMPATH NEERUKONDA M.D. (OWNER)
(607) 324-3580
Entity
Organization
Contact information
Practice address
1001 E 2ND ST, COUDERSPORT, PA 16915-8161
(800) 324-8820
Mailing address
111 E 14TH ST, ELMIRA HEIGHTS, NY 14903-1303
(607) 734-9539
(607) 734-6293
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD052162L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001713173
—
PA
Enumeration date
08/12/2008
Last updated
04/21/2009
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