Provider Demographics
NPI:1710282934
Name:SAINT ANDREWS NEUROSCIENCE(MEDICAL NEUROPSYCHIATRY)LLC
Entity Type:Organization
Organization Name:SAINT ANDREWS NEUROSCIENCE(MEDICAL NEUROPSYCHIATRY)LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUM
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-765-7470
Mailing Address - Street 1:55 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4705
Mailing Address - Country:US
Mailing Address - Phone:607-238-7062
Mailing Address - Fax:607-238-7087
Practice Address - Street 1:55 FRONT ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4705
Practice Address - Country:US
Practice Address - Phone:607-238-7062
Practice Address - Fax:607-238-7087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty