Provider Demographics
NPI:1093751026
Name:CENTRAL NEW YORK SURGICAL PHYSICIANS PC
Entity Type:Organization
Organization Name:CENTRAL NEW YORK SURGICAL PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-470-7364
Mailing Address - Street 1:739 IRVING AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-470-7364
Mailing Address - Fax:315-470-5859
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:STE 450
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-470-7364
Practice Address - Fax:315-470-5859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01746414Medicaid
NY01746414Medicaid
56409AMedicare ID - Type Unspecified