Provider Demographics
NPI:1922038116
Name:TAE SIK CHOI MD PC
Entity Type:Organization
Organization Name:TAE SIK CHOI MD PC
Other - Org Name:MASSENA OBGYN GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:C
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-764-0265
Mailing Address - Street 1:22 CENTER ST
Mailing Address - Street 2:PO BOX 111
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1437
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:315-764-1812
Practice Address - Street 1:22 CENTER ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1437
Practice Address - Country:US
Practice Address - Phone:315-764-0265
Practice Address - Fax:315-764-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01790216Medicaid
NY56853AMedicare PIN