Provider Demographics
NPI:1013969526
Name:NETANYAHU, IDDO (MD)
Entity Type:Individual
Prefix:DR
First Name:IDDO
Middle Name:
Last Name:NETANYAHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 THE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843
Mailing Address - Country:US
Mailing Address - Phone:607-324-2244
Mailing Address - Fax:
Practice Address - Street 1:411 CANISTEO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2104
Practice Address - Country:US
Practice Address - Phone:607-324-8255
Practice Address - Fax:607-324-8774
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1671922085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026402001OtherUNIVERA
NY000921963001OtherHEALTHNOW (BUFFALO)
NY542067663OtherUNITED HEALTHCARE
NYMDH356OtherPREFERRED CARE
NY01543131Medicaid
NYP010167192OtherBLUE CHOICE (GRIPA)
NYP010167195OtherBCBS
NYP010167192OtherBCBS OF CNY
NY542067663OtherUNITED HEALTHCARE
NY00026402001OtherUNIVERA