| Fourth Street Family Medicine | |
|
144 W 4th St Oswego NY 13126-2504 | |
| (315) 342-2521 | |
| (315) 342-4277 |
| Full Name | Fourth Street Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 144 W 4th St, Oswego, New York |
| Authorized Official Name and Position | Dhanraj Jattan Soogree (OWNER) |
| Authorized Official Contact | 3153422521 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fourth Street Family Medicine 144 W 4th St Oswego NY 13126-2504 Ph: (315) 342-2521 | Fourth Street Family Medicine 144 W 4th St Oswego NY 13126-2504 Ph: (315) 342-2521 |
| NPI Number | 1679745764 |
|---|---|
| Provider Enumeration Date | 03/28/2008 |
| Last Update Date | 02/22/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679745764 | NPI | - | NPPES |
| 01857538 | Medicaid | NY | |
| 1194755322 | Other | NY | BCBS NY EXCELLUS |
| 000115478 | Other | NY | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 210443 (New York) | Primary |
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