Provider Demographics
NPI:1093854333
Name:NORTHTOWN OBGYN PC
Entity Type:Organization
Organization Name:NORTHTOWN OBGYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAECHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-636-8284
Mailing Address - Street 1:6161 TRANSIT RD
Mailing Address - Street 2:SUITE#5
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2606
Mailing Address - Country:US
Mailing Address - Phone:716-636-8284
Mailing Address - Fax:716-636-5015
Practice Address - Street 1:6161 TRANSIT RD
Practice Address - Street 2:SUITE#5
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2606
Practice Address - Country:US
Practice Address - Phone:716-636-8284
Practice Address - Fax:716-636-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201585207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1392Medicare ID - Type Unspecified
NYG86217Medicare UPIN