Provider Demographics
NPI:1558796243
Name:GERIATRIC & PALLIATIVE SPECIALIST PC
Entity Type:Organization
Organization Name:GERIATRIC & PALLIATIVE SPECIALIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RENANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-216-4641
Mailing Address - Street 1:101 W UTICA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3165
Mailing Address - Country:US
Mailing Address - Phone:315-216-6865
Mailing Address - Fax:315-216-6867
Practice Address - Street 1:101 W UTICA ST
Practice Address - Street 2:SUITE C
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3165
Practice Address - Country:US
Practice Address - Phone:315-216-6865
Practice Address - Fax:315-216-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246837207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty