UPSTATE UNIVERSITY CLINICAL CAMPUS MEDICAL GROUP AT BINGHAMTON, INC. (NPI# 1265987325) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265987325 |
| Entity Type | Organization |
| Organization Name | UPSTATE UNIVERSITY CLINICAL CAMPUS MEDICAL GROUP AT BINGHAMTON, INC. |
| Other Organization Name | CLINICAL CAMPUS MEDICAL SERVICES GROUP |
| Practice Address |
46 Harrison St Johnson City NY 13790-2120 |
| Mailing Address |
425 Robinson St Binghamton NY 13904-1735 |
| Practice Telephone | 6077296531 |
| Practice Fax Number | 6072170110 |
| Mailing Telephone | 6077723516 |
| Mailing Fax Number | 6077723536 |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2016-08-18 |
| Authorized Official Name | DR. LENORE LYNN BORIS (PRACTICE PLAN MANAGER) |
| Authorized Official Telephone | 6077723516 |
| Authorized Official Credential | JD, PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Clinical Campus Medical Services Group | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | UPSTATE UNIVERSITY CLINICAL CAMPUS MEDICAL GROUP AT BINGHAMTON, INC. | 425 Robinson Street, Binghamton, New York 13904 |
| Street Address |
46 HARRISON ST |
| City | JOHNSON CITY |
| State | NY |
| Zip Code | 13790-2120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922085497 | Saeed Bajwa | Neurological Surgery | 46 Harrison St, Johnson City, NY 13790 | 2005-12-27 |
| 1174135305 | Milton Harding | Nurse Practitioner | 46 Harrison St, Johnson City, NY 13790-2120 | 2020-08-19 |
| 1821493263 | Oana Stingu | Physician Assistant | 46 Harrison St, Johnson City, NY 13790-2120 | 2014-10-28 |
| 1700297918 | Diana Rasmussen | Nurse Practitioner | 46 Harrison St, Southern New York Neurosurgical Group, P.C., Johnson City, NY 13790-2120 | 2014-05-12 |
| 1700096583 | Renny Stocum | Physician Assistant | 46 Harrison St, Johnson City, NY 13790-2120 | 2007-05-23 |
| 1225058530 | Christine Snyder | Physician Assistant | 46 Harrison St, Johnson City, NY 13790-2120 | 2006-07-20 |
| 1306866983 | Joseph Garrehy | Physician Assistant | 46 Harrison St, Johnson City, NY 13790-2120 | 2006-07-19 |
| 1831115351 | Joseph Andusko | Physician Assistant | 46 Harrison St, Johnson City, NY 13790-2120 | 2006-07-15 |
| 1932125788 | Southern New York Neurosurgical Group PC | Specialist | 46 Harrison St, Johnson City, NY 13790-2120 | 2006-07-14 |
| 1053374835 | Barry J Pollack | Neurological Surgery | 46 Harrison St, Johnson City, NY 13790-2120 | 2006-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578107645 | Thomas William Sorber | Occupational Therapist | 33 Harrison St, Johnson City, Johnson City, NY 13790 | 2019-11-01 |
| 1326534116 | Silver Linings Golden Memory Care | Clinic/Center | 4416 Watson Blvd, Johnson City, NY 13790 | 2018-07-05 |
| 1508308545 | Irene Mukeli Nzasi | Registered Nurse | 156 Corliss Ave Suite 107, Johnson City, NY 13790 | 2016-11-08 |
| 1053867754 | Tabitha Rae Toman | Physical Therapist | 34 Harrison St, Johnson City, NY 13790 | 2016-09-01 |
| 1235685066 | Dianne Brunner | Physical Therapist | 33-55 Harrison Street, Wilson Hospital, Johnson City, NY 13790 | 2016-08-31 |
| 1578982682 | Tracy Lynn Brown | Optometrist | 223 Reynolds Road, Johnson City, NY 13790 | 2014-04-16 |
| 1083041495 | Maryann Serbonich | Pharmacist | 52 Harrison Street, Johnson City, NY 13790 | 2013-09-30 |
| 1134464399 | Kasey Connor Folger | Speech-Language Pathologist | 3 Laurel St., Johnson City, NY 13790 | 2012-11-29 |
| 1467797571 | Bodyworks Physical Therapy LLC | Clinic/Center | 765 Harry L Drive, Johnson City, NY 13790 | 2012-11-29 |
| 1548518400 | Melissa L Korosec | Nurse Practitioner | 30 Harrison St., Suite 250, Johnson City, NY 13790 | 2012-08-27 |
| Find all providers in zip 13790 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194958215 | Tanzila Shams Kulman | Psychiatry & Neurology | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604 | 2009-08-24 |
| 1730387036 | Ray Wallace Mettetal Jr. | Psychiatry & Neurology | 303 E 11th Ave, Johnson City, TN 37601-3932 | 2007-07-07 |
| 1942310149 | Pamela J. Costello, Md, PC | Psychiatry & Neurology | 3915 Bristol Hwy Ste 103, Johnson City, TN 37601-1400 | 2006-08-30 |
| 1457365876 | Pamela J Costello | Psychiatry & Neurology | 3915 Bristol Hwy Ste 301, Johnson City, TN 37601-1403 | 2006-07-28 |
| 1992750673 | Yi Annette Huang | Psychiatry & Neurology | 105 Woodlawn Drive, Johnson City, TN 37604-5978 | 2006-05-23 |
| 1245213545 | Nathaniel Robb Whaley | Psychiatry & Neurology | 1321 Sunset Drive, Suite 11, Johnson City, TN 37604-7902 | 2005-11-22 |
| 1205830536 | Fernando Bendfeldt | Psychiatry & Neurology | 101 Med Tech Pkwy, Ste 407, Johnson City, TN 37604-4000 | 2005-05-23 |
| 1922574474 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604-6972 | 2018-10-22 |
| 1659776375 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604-6971 | 2014-10-23 |
| 1548503642 | Derek Y Yuan | Psychiatry & Neurology | 52 Harrison St Fl 2, Johnson City, NY 13790-2120 | 2013-03-27 |
| Find all providers in JOHNSON CITY | ||||
| City | JOHNSON CITY |
| Zip Code | 13790 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.