Healthcare Provider Details

I. General information

NPI: 1437229945
Provider Name (Legal Business Name): OB-GYN ASSOCIATES OF ITHACA, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ARROWOOD DR
ITHACA NY
14850-1857
US

IV. Provider business mailing address

20 ARROWOOD DR
ITHACA NY
14850-1857
US

V. Phone/Fax

Practice location:
  • Phone: 607-266-7800
  • Fax: 607-266-7811
Mailing address:
  • Phone: 607-266-7800
  • Fax: 607-266-7811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY M BOWERS
Title or Position: MANAGER
Credential: M
Phone: 607-266-7800