Provider Demographics
NPI:1891827663
Name:ADVANCED ENT PHYSICIANS & SURGEONS OF CNY PC
Entity Type:Organization
Organization Name:ADVANCED ENT PHYSICIANS & SURGEONS OF CNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-234-9865
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 229
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-234-9865
Mailing Address - Fax:315-234-9858
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 229
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-234-9865
Practice Address - Fax:315-234-9858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU10859Medicare UPIN
NY55304AMedicare ID - Type UnspecifiedGROUP
NYF29078Medicare UPIN
NYC64728Medicare UPIN