Internal Medicine of Ithaca, PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

218549 Issued in NY

Legal business name

INTERNAL MEDICINE OF ITHACA, PC

Practice address

2359 N Triphammer Rd
Ithaca, NY 14850-1059

Phone

(607) 257-3452

Fax

(607) 257-3612

NPI assigned

Sep 5, 2007

Last updated

Dec 7, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Muhammad Ahmad Wattoo, MDNPI 1437125895

Title

President

Phone

(607) 257-3452

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 1

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.

• Muhammad Ahmad Wattoo, MD

  • Internal Medicine Physician
  • Ithaca, NY
  • NPI 1437125895
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196985600000",
    "number": "1609060417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2359 N TRIPHAMMER RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501059",
            "telephone_number": "607-257-3452",
            "fax_number": "607-257-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2359 N TRIPHAMMER RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501059",
            "telephone_number": "607-257-3452",
            "fax_number": "607-257-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE OF ITHACA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2007-12-07",
        "status": "A",
        "authorized_official_last_name": "WATTOO",
        "authorized_official_first_name": "MUHAMMAD",
        "authorized_official_middle_name": "AHMAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "607-257-3452",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "218549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.