Provider Demographics
NPI:1427009802
Name:ITHACA UROLOGY PLLC
Entity Type:Organization
Organization Name:ITHACA UROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-273-8502
Mailing Address - Street 1:202 TAUGHANNOCK BLVD
Mailing Address - Street 2:PO BOX 366
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851
Mailing Address - Country:US
Mailing Address - Phone:607-277-3257
Mailing Address - Fax:607-277-4056
Practice Address - Street 1:1301 TRUMANSBURG ROAD
Practice Address - Street 2:SUITE M
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-273-8502
Practice Address - Fax:607-273-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0965Medicare ID - Type Unspecified