Healthcare Provider Details

I. General information

NPI: 1508816695
Provider Name (Legal Business Name): AUBURN INTERNAL MEDICINE AND PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 GENESEE ST SUITE 203
AUBURN NY
13021-2662
US

IV. Provider business mailing address

161 GENESEE ST SUITE 203
AUBURN NY
13021-3451
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-0947
  • Fax: 315-255-0942
Mailing address:
  • Phone: 315-255-0947
  • Fax: 315-255-0942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH GRANEY
Title or Position: OWNER/PARTNER
Credential: MD
Phone: 315-255-0947