Basic Information
| Provider Information | |||||||||
| NPI: | 1477927515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UPSTATE ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2005 | ||||||||
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| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154490513 | ||||||||
| FaxNumber: | 3153625120 | ||||||||
| Practice Location | |||||||||
| Address1: | 415 KING ST | ||||||||
| Address2: | |||||||||
| City: | OGDENSBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136691114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153933600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2015 | ||||||||
| LastUpdateDate: | 11/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | BENIAMIN | ||||||||
| AuthorizedOfficialFirstName: | MYRIAM | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3153933600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.