Provider Demographics
NPI:1760433361
Name:OBSTETRICAL-GYNECOLOGICAL ASSOCIATES OF THE SOUTHERN TIER, P.C.
Entity Type:Organization
Organization Name:OBSTETRICAL-GYNECOLOGICAL ASSOCIATES OF THE SOUTHERN TIER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BAI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-754-9870
Mailing Address - Street 1:24 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5214
Mailing Address - Country:US
Mailing Address - Phone:607-754-9870
Mailing Address - Fax:607-785-9862
Practice Address - Street 1:24 MADISON AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5214
Practice Address - Country:US
Practice Address - Phone:607-754-9870
Practice Address - Fax:607-785-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109953207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty