Provider Demographics
NPI:1972690196
Name:SURGICAL ASSOCIATES OF UTICA, PC
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF UTICA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GUGNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-797-3430
Mailing Address - Street 1:2206 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5829
Mailing Address - Country:US
Mailing Address - Phone:315-797-3430
Mailing Address - Fax:315-624-7383
Practice Address - Street 1:2206 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5829
Practice Address - Country:US
Practice Address - Phone:315-797-3430
Practice Address - Fax:315-624-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3168862086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID NUMBER