| 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  |