| Associated Gastroenterologists Of Central New York, Pc | |
|
260 Township Blvd Ste 20 Camillus NY 13031 | |
| (315) 708-0190 | |
| (315) 488-3284 |
| Full Name | Associated Gastroenterologists Of Central New York, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 260 Township Blvd, Camillus, New York |
| Authorized Official Name and Position | Carol Gallup (CREDENTIALING COORDINATOR) |
| Authorized Official Contact | 3152180085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Associated Gastroenterologists Of Central New York, Pc 260 Township Blvd Ste 20 Camillus NY 13031 Ph: (315) 708-0091 | Associated Gastroenterologists Of Central New York, Pc 260 Township Blvd Ste 20 Camillus NY 13031 Ph: (315) 708-0190 |
| NPI Number | 1013938174 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 3375512213 |
|---|---|
| Medicare Enrollment ID | O20040928000914 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013938174 | NPI | - | NPPES |
| 00482137 | Medicaid | NY | |
| CF1049 | Other | NY | R/R MEDICARE |
| CC7979 | Other | NY | R/R MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (New York) | Primary |
| Provider Name | Christian N Ezidiegwu |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1053364802 PECOS PAC ID: 5496746463 Enrollment ID: I20040519000662 |
| Provider Name | John H Sun |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1205840899 PECOS PAC ID: 7315986734 Enrollment ID: I20050426000762 |
| Provider Name | Rayees Nizam |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1154375087 PECOS PAC ID: 4082664537 Enrollment ID: I20100512000773 |
| Provider Name | Theodore J Koh |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1114931037 PECOS PAC ID: 0042248411 Enrollment ID: I20101213000949 |
| Provider Name | Syed Saeed Zaman |
|---|---|
| Provider Type | Practitioner - Pathology |
| Provider Identifiers | NPI Number: 1295729143 PECOS PAC ID: 0547441610 Enrollment ID: I20110222000992 |
| Provider Name | Margaret M Bailey |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1518946433 PECOS PAC ID: 0547443673 Enrollment ID: I20110325000767 |
| Provider Name | Christine M Granato |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1851535116 PECOS PAC ID: 6608027024 Enrollment ID: I20121113000320 |
| Provider Name | Lisa A Hawthorne |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275509416 PECOS PAC ID: 8022257716 Enrollment ID: I20130610000128 |
| Provider Name | Thomas C Lee |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1568652261 PECOS PAC ID: 0749445591 Enrollment ID: I20130730000510 |
| Provider Name | Qun Xu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689837684 PECOS PAC ID: 5890928725 Enrollment ID: I20140430001528 |
| Provider Name | Karen R Simbari |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467837484 PECOS PAC ID: 7416266986 Enrollment ID: I20151023000457 |
| Provider Name | Kathryn D Alder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235648858 PECOS PAC ID: 8628337326 Enrollment ID: I20180125000063 |
| Provider Name | Emily H Taeler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659744027 PECOS PAC ID: 6204139389 Enrollment ID: I20190802002546 |
| Provider Name | Kaylyn E Amuso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386206365 PECOS PAC ID: 5193054302 Enrollment ID: I20190913001599 |
| Provider Name | Melanie K Davis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619518511 PECOS PAC ID: 1951727932 Enrollment ID: I20200820003332 |
| Provider Name | Rachel A Babiarz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942828736 PECOS PAC ID: 0840618955 Enrollment ID: I20200922000193 |
| Provider Name | Stacey Jantsch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861091324 PECOS PAC ID: 7810304482 Enrollment ID: I20210326000084 |
| Provider Name | Margaret Spinosa |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1073047205 PECOS PAC ID: 4183084106 Enrollment ID: I20230721000756 |
Fairmount Family Medicine Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5006 West Genesee Street, Camillus, NY 13031 Phone: 315-234-2342 Fax: 315-234-0697 | |
Preventive Medicine Associates Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 5415 W Genesee St, Suite 301, Camillus, NY 13031 Phone: 315-487-8109 Fax: 315-487-5680 |