Provider Demographics
NPI:1417326661
Name:SYRACUSE GASTROENTEROLOGICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:SYRACUSE GASTROENTEROLOGICAL ASSOCIATES PC
Other - Org Name:SGA ANESTHESIA
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-234-4815
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4505
Mailing Address - Country:US
Mailing Address - Phone:315-449-0513
Mailing Address - Fax:315-362-5120
Practice Address - Street 1:739 IRVING AVE STE 420
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1652
Practice Address - Country:US
Practice Address - Phone:315-234-6677
Practice Address - Fax:315-234-4808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SYRACUSE GASTROENTEROLOGICAL ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty