Provider Demographics
| NPI: | 1184974529 |
|---|---|
| Name: | SUNY HEALTHSCIENCE CENTER AT SYRACUSE |
| Entity type: | Organization |
| Organization Name: | SUNY HEALTHSCIENCE CENTER AT SYRACUSE |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | STUART |
| Authorized Official - Middle Name: | M |
| Authorized Official - Last Name: | WRIGHT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 315-464-6530 |
| Mailing Address - Street 1: | 750 EAST ADAMS STREET |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SYRACUSE |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 13210-2306 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 315-464-6530 |
| Mailing Address - Fax: | 315-464-8333 |
| Practice Address - Street 1: | 750 EAST ADAMS STREET |
| Practice Address - Street 2: | |
| Practice Address - City: | SYRACUSE |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 13210-2306 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 315-464-6530 |
| Practice Address - Fax: | 315-464-8333 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-09-13 |
| Last Update Date: | 2023-06-19 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 103T00000X, 208M00000X, 261QM1300X, 363A00000X, 363AM0700X, 363AS0400X, 363L00000X, 363LA2100X, 363LA2200X, 363LC0200X, 363LF0000X, 363LP0200X, 363LP0808X | ||
| NY | 363LW0102X | |
| NY | 3301007H | 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
| No | 363LA2200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | Group - Multi-Specialty |
| No | 363LC0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Critical Care Medicine | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0200X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 363LW0102X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | 1578554630 | Other | NPI FOR ACUTE HOSPITAL |
| NY | 00354590 | Medicaid | |
| NY | 330241 | Other | MEDICARE PROVIDER NUMBER |
