Provider Demographics
NPI:1669619854
Name:OSWEGO SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:OSWEGO SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOLOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-207-0670
Mailing Address - Street 1:38 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3803
Mailing Address - Country:US
Mailing Address - Phone:315-207-0670
Mailing Address - Fax:315-207-0672
Practice Address - Street 1:38 ERIE ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3803
Practice Address - Country:US
Practice Address - Phone:315-207-0670
Practice Address - Fax:315-207-0672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-10
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251306208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000143OtherMEDICARE PTAN