Provider Demographics
NPI:1326041286
Name:LOFTUS, RYU & BARTOL MD'S PC
Entity Type:Organization
Organization Name:LOFTUS, RYU & BARTOL MD'S PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DITOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-671-0070
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1691
Mailing Address - Country:US
Mailing Address - Phone:315-671-0070
Mailing Address - Fax:315-475-0620
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:STE 108
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1691
Practice Address - Country:US
Practice Address - Phone:315-671-0070
Practice Address - Fax:315-475-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0960021174400000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBW9NMedicaid