Provider Demographics
NPI:1306869763
Name:GASTROENTEROLOGY ASSOCIATES OF PLATTSBURGH
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF PLATTSBURGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-562-7171
Mailing Address - Street 1:77 PLAZA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-6438
Mailing Address - Country:US
Mailing Address - Phone:518-562-7171
Mailing Address - Fax:518-562-7474
Practice Address - Street 1:77 PLAZA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6438
Practice Address - Country:US
Practice Address - Phone:518-562-7171
Practice Address - Fax:518-562-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01186938Medicaid
NY01186938Medicaid
NY56773CMedicare ID - Type Unspecified