Provider Demographics
NPI:1750471082
Name:UROLOGY ASSOCIATES OF NORTHEASTERN NEW YORK PC
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF NORTHEASTERN NEW YORK PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BANKO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-561-3900
Mailing Address - Street 1:15 DEGRANDPRE WAY
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6449
Mailing Address - Country:US
Mailing Address - Phone:418-561-3900
Mailing Address - Fax:518-561-7843
Practice Address - Street 1:15 DEGRANDPRE WAY
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6449
Practice Address - Country:US
Practice Address - Phone:518-561-3900
Practice Address - Fax:518-561-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153178208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUR33564EMedicare ID - Type UnspecifiedJOHN M BANKO MD
NYE44188Medicare UPIN
NYBB6329Medicare ID - Type UnspecifiedLEO GRAFSTEIN MD
NYD01974Medicare UPIN
NYF85682Medicare UPIN
NYUR33564DMedicare ID - Type UnspecifiedDIEGO GRINBERG-FUNES MD