Provider Demographics
NPI:1750410189
Name:FAMILY PRACTICE ASSOCIATES PLLC
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CARNESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-622-6758
Mailing Address - Street 1:8100 OSWEGO RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1654
Mailing Address - Country:US
Mailing Address - Phone:315-652-6551
Mailing Address - Fax:
Practice Address - Street 1:8100 OSWEGO RD
Practice Address - Street 2:SUITE 220
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-1654
Practice Address - Country:US
Practice Address - Phone:315-652-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty