Provider Demographics
NPI:1326043464
Name:HINTERBERGER, JOSEPH W (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:HINTERBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 STEUBEN STREET
Mailing Address - Street 2:
Mailing Address - City:MONTOUR FALLSA
Mailing Address - State:NY
Mailing Address - Zip Code:14865
Mailing Address - Country:US
Mailing Address - Phone:607-535-7121
Mailing Address - Fax:607-243-8483
Practice Address - Street 1:30 MILLARD ST
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:NY
Practice Address - Zip Code:14837-1024
Practice Address - Country:US
Practice Address - Phone:607-243-8311
Practice Address - Fax:607-243-8483
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01599146Medicaid
NYP010196510OtherEXCELLUS BCBS
NY5997157OtherGHI
NY000914169002OtherHEALTHNOW
NYP41754OtherGHIFHP
NY01599146Medicaid
NYP41754OtherGHIFHP
NYDD6563Medicare PIN