Provider Demographics
NPI:1578654828
Name:MOHAWK VALLEY SURGERY GROUP
Entity Type:Organization
Organization Name:MOHAWK VALLEY SURGERY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:NABEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EL-AMIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-733-7798
Mailing Address - Street 1:2211 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501
Mailing Address - Country:US
Mailing Address - Phone:315-733-7798
Mailing Address - Fax:315-733-7893
Practice Address - Street 1:2211 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:315-733-7798
Practice Address - Fax:315-733-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190295-1174400000X
NY203719-1174400000X
NY162144-1174400000X
NY196623-1174400000X
NY11616-1174400000X
NY183436174400000X
NY007138-1363A00000X
NY009013-1363A00000X
NY010940-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF86079Medicare UPIN
NYG32330Medicare UPIN
NYB81644Medicare UPIN
NYD02270Medicare UPIN
NYG57956Medicare UPIN
NYP69569Medicare UPIN
NYE92472Medicare UPIN
NYQ57697Medicare UPIN
NYP08068Medicare UPIN
NYR82367Medicare UPIN