UPSTATE GASTROENTEROLOGY LLC NPI 1366799033

NPI Information

NPI: 1366799033
Provider Name: UPSTATE GASTROENTEROLOGY, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 33D1051896

Address:
1000 E GENESEE ST
SUITE 206
SYRACUSE, NY
ZIP 13210
Phone: (315) 464-1616
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UPSTATE GASTROENTEROLOGY, LLC is an ambulatory surgical clinic center in Syracuse, NY. UPSTATE GASTROENTEROLOGY, LLC NPI is 1366799033. The provider is registered as an organization entity type.

The provider's business location address is:

1000 E GENESEE ST
SUITE 206
SYRACUSE, NY
ZIP 13210-892
Phone: (315) 464-1616
Fax: (315) 464-1617

The provider's authorized official is Michael C. Iannuzzi .
The authorized official title is Md and has the following contact phone number (315) 464-3835.

The CLIA number assigned to this NPI record is 33D1051896 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/13/2012 and was last updated on 3/2/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical	111362	NEW YORK	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	03747028	MEDICAID	NEW YORK
2	J300089429	MEDICARE PIN	NEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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