Basic Information
| Provider Information | |||||||||
| NPI: | 1417326661 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SYRACUSE GASTROENTEROLOGICAL ASSOCIATES PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SGA ANESTHESIA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2005 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154490513 | ||||||||
| FaxNumber: | 3153625120 | ||||||||
| Practice Location | |||||||||
| Address1: | 739 IRVING AVE STE 420 | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132101652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152346677 | ||||||||
| FaxNumber: | 3152344808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2015 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | DONA | ||||||||
| AuthorizedOfficialFirstName: | TABITHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3152344815 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SYRACUSE GASTROENTEROLOGICAL ASSOCIATES PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.