Provider Demographics
NPI:1487826574
Name:JOHN F GRIFFIN, PHYSICIAN PC
Entity Type:Organization
Organization Name:JOHN F GRIFFIN, PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-425-7722
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:STE 420
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-425-7722
Mailing Address - Fax:315-475-1705
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:STE 420
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-425-7722
Practice Address - Fax:315-475-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY108376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01199182Medicaid
56479AMedicare PIN
CA6267Medicare PIN
52072AMedicare PIN