Provider Demographics
NPI:1649259177
Name:BOYEA-KERTESZ, REBECCA E (PA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:E
Last Name:BOYEA-KERTESZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:E
Other - Last Name:BOYEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-470-7409
Mailing Address - Fax:315-475-2357
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1651
Practice Address - Country:US
Practice Address - Phone:315-470-7409
Practice Address - Fax:315-475-2357
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014281363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA2660Medicare PIN
NYJ400041678Medicare PIN
NYP00139470Medicare PIN