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General NPI Number Information
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NPI Number | 1407003890
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Entity Type | Organization
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Legal Business Name | NORTHTOWNS PSYCHIATRY PC
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/27/2008
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Provider Practice Location Address
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Address Line | 479 ENGLEWOOD AVE NORTHTOWNS PSYCHIATRY PC
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City | TONAWANDA
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State | NY
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Zip | 14223-2862
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Country | US
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Telephone | 716-831-9030
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Fax | 716-831-9075
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Provider Business Mailing Address
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Address Line | 479 ENGLEWOOD AVE
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City | TONAWANDA
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State | NY
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Zip | 14223-2862
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Country | US
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Telephone | 716-831-9030
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Fax | 716-831-9075
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Authorized Official
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Title or Position | OFFICER
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Name | DR. MICHAEL S MOGERMAN
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Credential | M.D.
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Telephone | 716-831-9030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 196919
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License Number State | NY
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