Provider Demographics
NPI:1669514592
Name:FAMILY PRACTICE ASSOCIATES, P.C
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-493-7334
Mailing Address - Street 1:40 FRANKLIN STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARTHAGE
Mailing Address - State:NY
Mailing Address - Zip Code:13619-1323
Mailing Address - Country:US
Mailing Address - Phone:315-493-7334
Mailing Address - Fax:315-493-4232
Practice Address - Street 1:40 FRANKLIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-1323
Practice Address - Country:US
Practice Address - Phone:315-493-7334
Practice Address - Fax:315-493-4232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty