Provider Demographics
NPI:1033638028
Name:ONEIDA MEDICAL PRACTICE, PC
Entity Type:Organization
Organization Name:ONEIDA MEDICAL PRACTICE, PC
Other - Org Name:ENT SPECIALISTS OF ONEIDA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-697-2033
Mailing Address - Street 1:221 BROAD ST - SUITE 201
Mailing Address - Street 2:ATTN: ENT SPECIALISTS OF ONEIDA
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2178
Mailing Address - Country:US
Mailing Address - Phone:315-363-5421
Mailing Address - Fax:315-363-5472
Practice Address - Street 1:221 BROAD ST - SUITE 201
Practice Address - Street 2:ATTN: ENT SPECIALISTS OF ONEIDA
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2178
Practice Address - Country:US
Practice Address - Phone:315-363-5421
Practice Address - Fax:315-363-5472
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONEIDA MEDICAL PRACTICE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-12
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03357884Medicaid