Provider Demographics
NPI:1932258985
Name:PEDIATRIC CARDIOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:J
Authorized Official - Last Name:BYRUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-214-7700
Mailing Address - Street 1:725 IRVING AVE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1603
Mailing Address - Country:US
Mailing Address - Phone:315-214-7700
Mailing Address - Fax:315-214-7701
Practice Address - Street 1:725 IRVING AVE
Practice Address - Street 2:SUITE 804
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1603
Practice Address - Country:US
Practice Address - Phone:315-214-7700
Practice Address - Fax:315-214-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00469443Medicaid
NYAA0907Medicare ID - Type Unspecified