Basic Information
Provider Information
NPI: 1023173002
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMSEY
FirstName: NATHANIEL
MiddleName: JAY
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1001 W FAYETTE ST
Address2: SUITE 400
City: SYRACUSE
State: NY
PostalCode: 132042859
CountryCode: US
TelephoneNumber: 3154721488
FaxNumber: 3154728060
Practice Location
Address1: 725 IRVING AVE
Address2:  
City: SYRACUSE
State: NY
PostalCode: 132101603
CountryCode: US
TelephoneNumber: 3154707111
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/27/2006
LastUpdateDate: 01/15/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400X011678-1NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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