Provider Demographics
NPI:1629241864
Name:ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC
Entity Type:Organization
Organization Name:ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-478-4185
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:ENROLLMENT DEPT
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4500
Mailing Address - Country:US
Mailing Address - Phone:315-362-5129
Mailing Address - Fax:315-362-5179
Practice Address - Street 1:4900 BROAD ROAD SUITE 3K
Practice Address - Street 2:COMMUNITY GENERAL HOSPITAL POB BUILDING NORTH
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215
Practice Address - Country:US
Practice Address - Phone:315-492-5882
Practice Address - Fax:315-492-5947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02922109Medicaid
6134580004Medicare NSC
BA1263Medicare PIN