Provider Demographics
NPI:1134223845
Name:PATHOLOGY ASSOCIATES OF SYRACUSE, PLLC
Entity type:Organization
Organization Name:PATHOLOGY ASSOCIATES OF SYRACUSE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:STRUMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-234-3300
Mailing Address - Street 1:600 E GENESEE ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3130
Mailing Address - Country:US
Mailing Address - Phone:315-234-3300
Mailing Address - Fax:
Practice Address - Street 1:600 E GENESEE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3130
Practice Address - Country:US
Practice Address - Phone:315-234-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174465-1291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02440884Medicaid
NY02440884Medicaid
NYCC5405Medicare ID - Type Unspecified