Healthcare Provider Details

I. General information

NPI: 1861996886
Provider Name (Legal Business Name): JOHN DAVID VOLCKO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 10/03/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HUTCHINGS PSYCHIATRIC CENTER 620 MADISON STREET
SYRACUSE NY
13210-9294
US

IV. Provider business mailing address

2808 HILTONWOOD RD
BALDWINSVILLE NY
13027-9294
US

V. Phone/Fax

Practice location:
  • Phone: 315-426-3600
  • Fax:
Mailing address:
  • Phone: 315-635-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number490329
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: