Basic Information
Provider Information | |||||||||
NPI: | 1689013450 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PHILOPENA | ||||||||
FirstName: | RHONDA | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DIESCHER | ||||||||
OtherFirstName: | RHONDA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 251 SALINA MEADOWS PKWY | ||||||||
Address2: | STE 100 | ||||||||
City: | SYRACUSE | ||||||||
State: | NY | ||||||||
PostalCode: | 132124516 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3154642000 | ||||||||
FaxNumber: | 3154642010 | ||||||||
Practice Location | |||||||||
Address1: | 4900 BROAD RD 1ST FL | ||||||||
Address2: |   | ||||||||
City: | SYRACUSE | ||||||||
State: | NY | ||||||||
PostalCode: | 13215 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3154925437 | ||||||||
FaxNumber: | 3154925502 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/14/2013 | ||||||||
LastUpdateDate: | 12/14/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PP0204X | 286154 | NY | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine | Pediatric Emergency Medicine |
No ID Information.