Provider Demographics
NPI:1669615605
Name:GREATER BINGHAMTON OBSTETRICS AND GYNECOLOGY,PLLC
Entity type:Organization
Organization Name:GREATER BINGHAMTON OBSTETRICS AND GYNECOLOGY,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMENICO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEUCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-727-5805
Mailing Address - Street 1:365 HARRY L DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1471
Mailing Address - Country:US
Mailing Address - Phone:607-729-5805
Mailing Address - Fax:607-729-7714
Practice Address - Street 1:365 HARRY L DR
Practice Address - Street 2:SUITE 110
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1471
Practice Address - Country:US
Practice Address - Phone:607-729-5805
Practice Address - Fax:607-729-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty