Provider Demographics
NPI:1518017821
Name:ADIRONDACK NEUROSURGICAL SPECIALIST
Entity Type:Organization
Organization Name:ADIRONDACK NEUROSURGICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:SOULTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-792-3617
Mailing Address - Street 1:2206 GENESEE STREET
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502
Mailing Address - Country:US
Mailing Address - Phone:315-792-7629
Mailing Address - Fax:315-792-3617
Practice Address - Street 1:2206 GENESEE STREET
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502
Practice Address - Country:US
Practice Address - Phone:315-792-7629
Practice Address - Fax:315-792-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0338Medicare ID - Type Unspecified