Provider Demographics
NPI:1578528048
Name:PRY, PAUL E (MSN, RN, NP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:PRY
Suffix:
Gender:M
Credentials:MSN, RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA HOSPITAL ANTICOAGULATION CLINIC
Mailing Address - Street 2:800 IRVING AVE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-425-2615
Mailing Address - Fax:315-425-2616
Practice Address - Street 1:800 IRVING AVE
Practice Address - Street 2:ANTICOAGULATION CLINIC
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2716
Practice Address - Country:US
Practice Address - Phone:315-425-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332260363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health