Provider Demographics
NPI:1508229659
Name:CARLOS DATOR JR., M.D., P.C.
Entity Type:Organization
Organization Name:CARLOS DATOR JR., M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:O
Authorized Official - Last Name:DATOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-343-2151
Mailing Address - Street 1:177 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3009
Mailing Address - Country:US
Mailing Address - Phone:315-343-2151
Mailing Address - Fax:
Practice Address - Street 1:177 W 4TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3009
Practice Address - Country:US
Practice Address - Phone:315-343-2151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281672261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care