Broome Surgery & Breast Care, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

License

0154223 Issued in NY

Legal business name

BROOME SURGERY & BREAST CARE, P.C.

Practice address

240 Riverside Dr
Suite 3
Johnson City, NY 13790-2732

Phone

(607) 729-0443

Fax

(607) 766-9395

NPI assigned

Jan 8, 2008

Organization subpart

No

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

Authorized official

Name

Ghassem Mangouri, M.D.

Title

President

Phone

(607) 729-0443

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202342400000",
    "number": "1790960839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 RIVERSIDE DR",
            "address_2": "SUITE 3",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902732",
            "telephone_number": "607-729-0443",
            "fax_number": "607-766-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 RIVERSIDE DR",
            "address_2": "SUITE 3",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902732",
            "telephone_number": "607-729-0443",
            "fax_number": "607-766-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOME SURGERY & BREAST CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-02-07",
        "status": "A",
        "authorized_official_last_name": "MANGOURI",
        "authorized_official_first_name": "GHASSEM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "607-729-0443",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "0154223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00775599",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diana L Brewer, MS, CCC-SLP
• Aaron Bridgemohan
• Tyson Don Brierley, D.O.
• Broome Oncology LLC
• Broome Orthopedic & Sport Physical Therapy
• John Brosnan, MD
• Calvin William Brown, LCSW-R
• Molly Brown, DPT
• Stefani M Brown, MS, CCC-SLP
• Tracy Lynn Brown, OD

• Specialist in Johnson City, NY
• Providers in Johnson City, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2008; 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.