Provider Demographics
NPI:1841289113
Name:CARDIAC SURGERY ASSOCIATES OF CNY PC
Entity type:Organization
Organization Name:CARDIAC SURGERY ASSOCIATES OF CNY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-423-7192
Mailing Address - Street 1:104 UNION AVE
Mailing Address - Street 2:SUITE 1001-1002
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-423-7192
Mailing Address - Fax:315-423-8013
Practice Address - Street 1:104 UNION AVE
Practice Address - Street 2:SUITE 1001-1002
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-423-7192
Practice Address - Fax:315-423-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02195059Medicaid
NY02195059Medicaid