Provider Demographics
NPI:1033497136
Name:AGCNY PHYSICIANS PLLC
Entity Type:Organization
Organization Name:AGCNY PHYSICIANS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-492-5292
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4500
Mailing Address - Country:US
Mailing Address - Phone:315-449-0513
Mailing Address - Fax:311-544-5293
Practice Address - Street 1:4309 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6638
Practice Address - Country:US
Practice Address - Phone:315-329-7300
Practice Address - Fax:315-329-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty