Provider Demographics
NPI:1508070392
Name:ALBERT THOMAS TRIPODI, M.D.PLLC
Entity Type:Organization
Organization Name:ALBERT THOMAS TRIPODI, M.D.PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:TRIPODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-476-2323
Mailing Address - Street 1:1101 ERIE BLVD E STE 201
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1144
Mailing Address - Country:US
Mailing Address - Phone:315-476-2323
Mailing Address - Fax:315-476-2438
Practice Address - Street 1:1101 ERIE BLVD E STE 201
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1144
Practice Address - Country:US
Practice Address - Phone:315-476-2323
Practice Address - Fax:315-476-2438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177301174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01230551Medicaid
NY52480BMedicare ID - Type Unspecified
NYF00936Medicare UPIN