Provider Demographics
NPI:1891104899
Name:NINE RIVERS OSTEOPATHY PC
Entity Type:Organization
Organization Name:NINE RIVERS OSTEOPATHY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:510-220-0890
Mailing Address - Street 1:118 PARK LN
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6352
Mailing Address - Country:US
Mailing Address - Phone:607-257-0900
Mailing Address - Fax:607-257-0997
Practice Address - Street 1:200 PLEASANT GROVE RD STE 6
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2664
Practice Address - Country:US
Practice Address - Phone:607-257-0900
Practice Address - Fax:607-257-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty