1013118603 NPI number — PALLIATIVE CARE PHYSICIANS OF CENTRAL NEW YORK

Table of content: (NPI 1013118603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013118603 NPI number — PALLIATIVE CARE PHYSICIANS OF CENTRAL NEW YORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALLIATIVE CARE PHYSICIANS OF CENTRAL NEW YORK
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:
Provider Other Organization Name Type Code:
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:
1013118603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 KENDALL ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
CLIFTON SPRINGS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14432-9701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-462-9482
Provider Business Mailing Address Fax Number:
315-462-5438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 7TH NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13088-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-634-1100
Provider Business Practice Location Address Fax Number:
315-634-1111
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SETLA
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER AND OWNER
Authorized Official Telephone Number:
315-634-2214

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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