Provider Demographics
NPI:1932266806
Name:ORTHOPEDICS EAST PC
Entity Type:Organization
Organization Name:ORTHOPEDICS EAST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:DICHRISTINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-251-0401
Mailing Address - Street 1:183 INTREPID LANE
Mailing Address - Street 2:
Mailing Address - City:SYRACRUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205
Mailing Address - Country:US
Mailing Address - Phone:315-251-0401
Mailing Address - Fax:315-251-0405
Practice Address - Street 1:183 INTREPID LANE
Practice Address - Street 2:
Practice Address - City:SYRACRUSE
Practice Address - State:NY
Practice Address - Zip Code:13205
Practice Address - Country:US
Practice Address - Phone:315-251-0401
Practice Address - Fax:315-251-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0959Medicare PIN