Henry S Roane, | |
600 East Genesee St, Suite 130, Syracuse, NY 13202 | |
(315) 464-3103 | |
(315) 464-3944 |
Full Name | Henry S Roane |
---|---|
Gender | Male |
Speciality | Psychologist - Cognitive & Behavioral |
Location | 600 East Genesee St, Syracuse, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467579730 | NPI | - | NPPES |
10025287200 | Medicaid | NE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TB0200X | Psychologist - Cognitive & Behavioral | 018405 (New York) | Primary |
103TB0200X | Psychologist - Cognitive & Behavioral | 667 (Nebraska) | Secondary |
Entity Name | Pediatric Service Group |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1770539066 PECOS PAC ID: 9931007200 Enrollment ID: O20031223000483 |
Mailing Address | Practice Location Address |
---|---|
Henry S Roane, 251 Salina Meadows Pkwy, Suite 100, Syracuse, NY 13212-4516 Ph: (315) 464-2000 | Henry S Roane, 600 East Genesee St, Suite 130, Syracuse, NY 13202 Ph: (315) 464-3103 |
Stephen Albert Maisto, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 800 Irving Ave, Syracuse, NY 13210 Phone: 315-425-6546 | |
Roger Di Pietro, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 600 E Genesee St, 217, Syracuse, NY 13202 Phone: 315-422-0300 Fax: 315-479-8455 | |
Dr. Sipho Mbuqe, PH.D. Psychologist Medicare: Medicare Enrolled Practice Location: 750 E Adams St, Syracuse, NY 13210 Phone: 315-464-3258 | |
Paige C Ouimette, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 4317 E Genesee St, Suite 202, Syracuse, NY 13214 Phone: 315-436-5825 | |
Laura Lee Mcintyre, PHD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 750 E Adams St, Syracuse, NY 13210 Phone: 315-464-4842 Fax: 315-464-7564 | |
Gabrielle Adamitis, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 800 Irving Ave, Syracuse, NY 13210 Phone: 315-425-4400 | |
Dr. Mark Richard Minnick, PH.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 620 Erie Blvd W, Syracuse, NY 13204 Phone: 315-425-4400 |