Provider Demographics
NPI:1437229945
Name:OB-GYN ASSOCIATES OF ITHACA, LLP
Entity Type:Organization
Organization Name:OB-GYN ASSOCIATES OF ITHACA, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:M
Authorized Official - Phone:607-266-7800
Mailing Address - Street 1:20 ARROWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1857
Mailing Address - Country:US
Mailing Address - Phone:607-266-7800
Mailing Address - Fax:607-266-7811
Practice Address - Street 1:20 ARROWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1857
Practice Address - Country:US
Practice Address - Phone:607-266-7800
Practice Address - Fax:607-266-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02079147Medicaid
NY02079147Medicaid