Basic Information
| Provider Information | |||||||||
| NPI: | 1235425372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDINGER | ||||||||
| FirstName: | LORETTA | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W FAYETTE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132042856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154721488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5-7 STATE STREET | ||||||||
| Address2: | |||||||||
| City: | TULLY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 131593218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156964635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2011 | ||||||||
| LastUpdateDate: | 01/16/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 336816 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 03349997 | 05 | NY | MEDICAID |