1730248022 NPI number — COLON RECTAL ASSOCIATES OF CENTRAL NEW YORK, LLP

Table of content: (NPI 1730248022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730248022 NPI number — COLON RECTAL ASSOCIATES OF CENTRAL NEW YORK, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLON RECTAL ASSOCIATES OF CENTRAL NEW YORK, LLP
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:
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Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1730248022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
GLACIER CREEK OFFICE PARK - BLDG II
Provider Second Line Business Mailing Address:
6711 TOWPATH RD., SUITE 175
Provider Business Mailing Address City Name:
EAST SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13057-9510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-458-2211
Provider Business Mailing Address Fax Number:
315-452-9025

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
GLACIER CREEK OFFICE PARK - BLDG II
Provider Second Line Business Practice Location Address:
6711 TOWPATH RD., SUITE 175
Provider Business Practice Location Address City Name:
EAST SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13057-9510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-458-2211
Provider Business Practice Location Address Fax Number:
315-452-9025
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLSON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
315-458-2211

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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