Provider Demographics
NPI:1528386919
Name:TGO MEDICINE PC
Entity Type:Organization
Organization Name:TGO MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-330-4173
Mailing Address - Street 1:244 MADISON AVE
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2817
Mailing Address - Country:US
Mailing Address - Phone:516-330-4173
Mailing Address - Fax:
Practice Address - Street 1:244 MADISON AVE
Practice Address - Street 2:SUITE 3G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2817
Practice Address - Country:US
Practice Address - Phone:516-330-4173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG79589Medicare UPIN