Provider Demographics
NPI:1033268198
Name:COLORECTAL SURGERY & MEDICINE, PC
Entity Type:Organization
Organization Name:COLORECTAL SURGERY & MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MRUGENDRA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-739-2890
Mailing Address - Street 1:2977 WESTINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8120
Mailing Address - Country:US
Mailing Address - Phone:607-739-2890
Mailing Address - Fax:607-739-2893
Practice Address - Street 1:2977 WESTINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8120
Practice Address - Country:US
Practice Address - Phone:607-739-2890
Practice Address - Fax:607-739-2893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224413208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD07180Medicare UPIN