Provider Demographics
NPI:1508816695
Name:AUBURN INTERNAL MEDICINE AND PEDIATRICS, LLC
Entity type:Organization
Organization Name:AUBURN INTERNAL MEDICINE AND PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-255-0947
Mailing Address - Street 1:161 GENESEE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3451
Mailing Address - Country:US
Mailing Address - Phone:315-255-0947
Mailing Address - Fax:315-255-0942
Practice Address - Street 1:161 GENESEE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-255-0947
Practice Address - Fax:315-255-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02022640Medicaid
NYAA0629Medicare PIN