Provider Demographics
NPI:1275681926
Name:UROLOGY SPECIALISTS OF CNY, PC
Entity Type:Organization
Organization Name:UROLOGY SPECIALISTS OF CNY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELHASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-753-9076
Mailing Address - Street 1:6 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1257
Mailing Address - Country:US
Mailing Address - Phone:607-753-9076
Mailing Address - Fax:607-753-7503
Practice Address - Street 1:6 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1257
Practice Address - Country:US
Practice Address - Phone:607-753-9076
Practice Address - Fax:607-753-7503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140686208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01539486Medicaid
NY01539486Medicaid