Provider Demographics
NPI:1659337152
Name:HAMBURG REGIONAL GYNECOLOGY, PC
Entity Type:Organization
Organization Name:HAMBURG REGIONAL GYNECOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:LAURIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-649-6500
Mailing Address - Street 1:4154 MCKINLEY PKWY
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2995
Mailing Address - Country:US
Mailing Address - Phone:716-649-6500
Mailing Address - Fax:716-649-0031
Practice Address - Street 1:4154 MCKINLEY PKWY
Practice Address - Street 2:SUITE 1200
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2995
Practice Address - Country:US
Practice Address - Phone:716-649-6500
Practice Address - Fax:716-649-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01406808Medicaid
NY01406808Medicaid
NY064811Medicare ID - Type Unspecified