Organization
BROOME SURGERY & BREAST CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GHASSEM MANGOURI M.D. (PRESIDENT)
(607) 729-0443
Entity
Organization
Contact information
Practice address
240 RIVERSIDE DR, SUITE 3, JOHNSON CITY, NY 13790-2732
(607) 729-0443
(607) 766-9395
Mailing address
240 RIVERSIDE DR, SUITE 3, JOHNSON CITY, NY 13790-2732
(607) 729-0443
(607) 766-9395
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0154223
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00775599
—
NY
Enumeration date
01/08/2008
Last updated
02/07/2008
Update your record
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