Healthcare Provider Details

I. General information

NPI: 1144242876
Provider Name (Legal Business Name): PATHOLOGY ASSOCIATES OF SYRACUSE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BROAD ST
HAMILTON NY
13346-9575
US

IV. Provider business mailing address

4567 CROSSROADS PARK DR
LIVERPOOL NY
13088-3589
US

V. Phone/Fax

Practice location:
  • Phone: 315-824-1100
  • Fax:
Mailing address:
  • Phone: 315-295-2100
  • Fax: 315-295-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number174465
License Number StateNY

VIII. Authorized Official

Name: MIKE SOVOCOOL
Title or Position: FINANCIAL ADVISOR
Credential:
Phone: 315-470-7396