Provider Demographics
NPI:1184142697
Name:ONEIDA MEDICAL PRACTICE, PC
Entity type:Organization
Organization Name:ONEIDA MEDICAL PRACTICE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-697-2033
Mailing Address - Street 1:3 CURTIS RD
Mailing Address - Street 2:ATTN: TRIVALLEY
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-3607
Mailing Address - Country:US
Mailing Address - Phone:315-697-2033
Mailing Address - Fax:315-829-2220
Practice Address - Street 1:3 CURTIS RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476
Practice Address - Country:US
Practice Address - Phone:315-829-2220
Practice Address - Fax:315-829-3955
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONEIDA MEDICAL PRACTICE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03357884Medicaid