1184933848 NPI number — CROUSE MEDICAL PRACTICE PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184933848 NPI number — CROUSE MEDICAL PRACTICE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROUSE MEDICAL PRACTICE PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
INTERNIST ASSOCIATES OF CENTRAL NEW YORK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184933848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
730 S CROUSE AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13210-1754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-479-5070
Provider Business Mailing Address Fax Number:
315-701-2520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
739 IRVING AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-1651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-479-5070
Provider Business Practice Location Address Fax Number:
315-701-2520
Provider Enumeration Date:
09/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DEC
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
315-701-2550

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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