Provider Demographics
NPI:1497788574
Name:NEUROSURGICAL ASSOCIATES OF CENTRAL NEW YORK, LLP
Entity Type:Organization
Organization Name:NEUROSURGICAL ASSOCIATES OF CENTRAL NEW YORK, LLP
Other - Org Name:UPSTATE BRAIN AND SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-464-4470
Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:613 JACOBSEN HALL
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-4470
Mailing Address - Fax:315-464-5520
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-464-4470
Practice Address - Fax:315-464-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02223641Medicaid
NY02223641Medicaid