Provider Demographics
NPI:1104026145
Name:ANDREW Y SOH, M.D.
Entity type:Organization
Organization Name:ANDREW Y SOH, M.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-871-0171
Mailing Address - Street 1:2950 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-1304
Mailing Address - Country:US
Mailing Address - Phone:716-871-0171
Mailing Address - Fax:716-871-0183
Practice Address - Street 1:2950 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1304
Practice Address - Country:US
Practice Address - Phone:716-871-0171
Practice Address - Fax:716-871-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172437207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010170201OtherUNIVERA
NY000510477002OtherBLUE CROSS BLUE SHIELD WN
NY2706544OtherINDEPENDENT HEALTH
NY01218271Medicaid
NY00010170201OtherUNIVERA