| Suny Upstate | |
|
90 Presidential Plz Syracuse NY 13202-2240 | |
| (315) 464-3833 | |
| Not Available |
| Full Name | Suny Upstate |
|---|---|
| Speciality | Clinic/center |
| Location | 90 Presidential Plz, Syracuse, New York |
| Authorized Official Name and Position | Viktoria Kenney (FNP) |
| Authorized Official Contact | 6077597462 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Suny Upstate 5104 Waterford Wood Way Fayetteville NY 13066-9799 Ph: (607) 759-7462 | Suny Upstate 90 Presidential Plz Syracuse NY 13202-2240 Ph: (315) 464-3833 |
| NPI Number | 1053789610 |
|---|---|
| Provider Enumeration Date | 09/11/2015 |
| Last Update Date | 09/11/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053789610 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | F339820-1 (New York) | Primary |
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