Provider Demographics
NPI:1467538991
Name:SYRACUSE GASTROENTEROLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:SYRACUSE GASTROENTEROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:H
Authorized Official - Last Name:KASOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-234-4818
Mailing Address - Street 1:730 S CROUSE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1713
Mailing Address - Country:US
Mailing Address - Phone:315-234-4818
Mailing Address - Fax:315-234-4807
Practice Address - Street 1:10 EATON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1124
Practice Address - Country:US
Practice Address - Phone:315-234-4818
Practice Address - Fax:315-234-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty