Provider Demographics
NPI:1033528948
Name:FAIRWAY MANAGEMENT, LLC
Entity Type:Organization
Organization Name:FAIRWAY MANAGEMENT, LLC
Other - Org Name:INDEED WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-682-0325
Mailing Address - Street 1:240 W SENECA ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-3401
Mailing Address - Country:US
Mailing Address - Phone:315-682-0328
Mailing Address - Fax:315-682-0295
Practice Address - Street 1:240 W SENECA ST
Practice Address - Street 2:SUITE 8
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-3401
Practice Address - Country:US
Practice Address - Phone:315-682-0328
Practice Address - Fax:315-682-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33D2071872291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory