Basic Information
Provider Information
NPI: 1922092154
EntityType: 2
ReplacementNPI:  
OrganizationName: HAMILTON CRITICAL CARE AND EMERGENCY CONSULTANTS PC
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Mailing Information
Address1: PO BOX 2004
Address2:  
City: EAST SYRACUSE
State: NY
PostalCode: 130574504
CountryCode: US
TelephoneNumber: 3153625285
FaxNumber: 3154452936
Practice Location
Address1: 150 BROAD ST
Address2:  
City: HAMILTON
State: NY
PostalCode: 133469575
CountryCode: US
TelephoneNumber: 3158246090
FaxNumber: 3158241956
Other Information
ProviderEnumerationDate: 09/02/2005
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: JASTREMSKI
AuthorizedOfficialFirstName: MICHAEL
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AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 3158246090
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansEmergency Medicine 

ID Information
IDTypeStateIssuerDescription
0147447305NY MEDICAID


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