Healthcare Provider Details

I. General information

NPI: 1326043464
Provider Name (Legal Business Name): JOSEPH W HINTERBERGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MILLARD ST
DUNDEE NY
14837-1024
US

IV. Provider business mailing address

220 STEUBEN STREET
MONTOUR FALLSA NY
14865
US

V. Phone/Fax

Practice location:
  • Phone: 607-243-8311
  • Fax: 607-243-8483
Mailing address:
  • Phone: 607-535-7121
  • Fax: 607-243-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number196510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: