Healthcare Provider Details

I. General information

NPI: 1013969526
Provider Name (Legal Business Name): IDDO NETANYAHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CANISTEO ST
HORNELL NY
14843-2104
US

IV. Provider business mailing address

5 THE CIRCLE
HORNELL NY
14843
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-8255
  • Fax: 607-324-8774
Mailing address:
  • Phone: 607-324-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number167192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: