Provider Demographics
NPI:1750314498
Name:ST. JOSEPH'S EKG ASSOCIATES, LLP
Entity Type:Organization
Organization Name:ST. JOSEPH'S EKG ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHIRSTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NARDONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-752-0141
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2337
Mailing Address - Country:US
Mailing Address - Phone:315-422-6705
Mailing Address - Fax:315-422-3909
Practice Address - Street 1:301 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-1807
Practice Address - Country:US
Practice Address - Phone:315-448-5202
Practice Address - Fax:315-448-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01072980Medicaid
NY01072980Medicaid
NYCD8168Medicare PIN
NY51137AMedicare PIN