Provider Demographics
NPI:1457499527
Name:ANDREW J. RURKA, MD
Entity Type:Organization
Organization Name:ANDREW J. RURKA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:RURKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-475-6101
Mailing Address - Street 1:1200 E GENESEE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1968
Mailing Address - Country:US
Mailing Address - Phone:315-475-6101
Mailing Address - Fax:315-475-1827
Practice Address - Street 1:1200 E GENESEE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1968
Practice Address - Country:US
Practice Address - Phone:315-475-6101
Practice Address - Fax:315-475-1827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00547008Medicaid