Provider Demographics
NPI:1740276203
Name:RIVERSIDE ASSOCIATES IN ANESTHESIA PC
Entity type:Organization
Organization Name:RIVERSIDE ASSOCIATES IN ANESTHESIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:W.
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MONTEITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-722-7264
Mailing Address - Street 1:38-40 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905-4712
Mailing Address - Country:US
Mailing Address - Phone:607-722-7264
Mailing Address - Fax:607-722-7869
Practice Address - Street 1:OUR LADY OF LOURDES HOSPITAL
Practice Address - Street 2:169 RIVERSIDE DRIVE
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905-4246
Practice Address - Country:US
Practice Address - Phone:607-722-7264
Practice Address - Fax:607-722-7869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00467469Medicaid
1130615082OtherTRAVELERS MEDICARE
PA0912726Medicaid
NY00467469Medicaid