Provider Demographics
NPI:1366469389
Name:SYRACUSE VA MEDICAL CENTER
Entity Type:Organization
Organization Name:SYRACUSE VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORD; HCHV PROGRAM
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ERNENWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:315-425-4400
Mailing Address - Street 1:1031 E FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1022
Mailing Address - Country:US
Mailing Address - Phone:315-425-4400
Mailing Address - Fax:315-425-4406
Practice Address - Street 1:1031 E FAYETTE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1022
Practice Address - Country:US
Practice Address - Phone:315-425-4400
Practice Address - Fax:315-425-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5006719282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital