Provider Demographics
NPI:1952675399
Name:MARY L OOT, FNP, P.C.
Entity Type:Organization
Organization Name:MARY L OOT, FNP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OOT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:315-627-0448
Mailing Address - Street 1:5900 N BURDICK ST STE 204
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9464
Mailing Address - Country:US
Mailing Address - Phone:315-627-0448
Mailing Address - Fax:315-627-0554
Practice Address - Street 1:5900 N BURDICK ST STE 204
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9464
Practice Address - Country:US
Practice Address - Phone:315-627-0448
Practice Address - Fax:315-627-0554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP27264Medicare UPIN