NPIMap

Organization Active NPI

Western New York Med-Psych PLLC

  • Psychiatry Physician
  • Coudersport, PA
National Provider Identifier
1568618353
Registry record updated Apr 21, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
MD052162L Issued in PA
Legal business name
WESTERN NEW YORK MED-PSYCH PLLC
Practice address
1001 E 2ND St
Coudersport, PA 16915-8161
Phone
(800) 324-8820
NPI assigned
Aug 12, 2008
Last updated
Apr 21, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
WESTERN NEW YORK MED-PSYCH PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sampath Neerukonda, M.D.NPI 1801842919
Title
Owner
Phone
(607) 324-3580

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X MD052162L PA Primary

Addresses

Primary practice location

1001 E 2ND St
Coudersport, PA 16915-8161

Mailing address

111 E 14TH St
Elmira Heights, NY 14903-1303
Phone (607) 734-9539

Other identifiers 1

IdentifierTypeStateIssuer
001713173MedicaidPA

National Provider Directory

National Provider Directory
Part of
Western New York Med-Psych PLLC

Locations

111 E 14th St
Elmira Hts, NY 14903

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240272000000",
    "number": "1568618353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E 14TH ST",
            "city": "ELMIRA HEIGHTS",
            "state": "NY",
            "postal_code": "149031303",
            "telephone_number": "607-734-9539",
            "fax_number": "607-734-6293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E 2ND ST",
            "city": "COUDERSPORT",
            "state": "PA",
            "postal_code": "169158161",
            "telephone_number": "800-324-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN NEW YORK MED-PSYCH PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WESTERN NEW YORK MED-PSYCH PLLC",
        "enumeration_date": "2008-08-12",
        "last_updated": "2009-04-21",
        "status": "A",
        "authorized_official_last_name": "NEERUKONDA",
        "authorized_official_first_name": "SAMPATH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "607-324-3580",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "MD052162L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001713173",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coudersport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.