Provider Demographics
NPI:1790873933
Name:INTERNAL MEDICINE ASSOCIATES OF AUBURN
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF AUBURN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REISSIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-4463
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUTIE 310
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1944
Mailing Address - Country:US
Mailing Address - Phone:315-253-4463
Mailing Address - Fax:315-253-5462
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUTIE 310
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-253-4463
Practice Address - Fax:315-253-5462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00439230Medicaid
NY34411AMedicare PIN