| Fayetteville Family Physician, Pllc | |
|
6834 E Genesee St Fayetteville NY 13066-1021 | |
| (315) 214-3999 | |
| (347) 772-3132 |
| Full Name | Fayetteville Family Physician, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6834 E Genesee St, Fayetteville, New York |
| Authorized Official Name and Position | Hdayatu Salawu (PHYSICIAN) |
| Authorized Official Contact | 3152143999 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fayetteville Family Physician, Pllc 6834 East Genesee Street Fayetteville NY 13066 Ph: (315) 214-3999 | Fayetteville Family Physician, Pllc 6834 E Genesee St Fayetteville NY 13066-1021 Ph: (315) 214-3999 |
| NPI Number | 1164708707 |
|---|---|
| Provider Enumeration Date | 10/27/2011 |
| Last Update Date | 10/27/2011 |
| Medicare PECOS PAC ID | 2365615523 |
|---|---|
| Medicare Enrollment ID | O20111103000207 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164708707 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 2462581 (New York) | Primary |
| Provider Name | Hdayatu Salawu |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831379874 PECOS PAC ID: 0749360378 Enrollment ID: I20080108000604 |
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