Healthcare Provider Details

I. General information

NPI: 1518047810
Provider Name (Legal Business Name): ONONDAGA HILL INTERNISTS, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD POB N., STE. 2S
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

1001 W FAYETTE ST SUITE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5791
  • Fax: 315-492-5855
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-476-1792

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 Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: AJAZ BASHIR SHAWL
Title or Position: PARTNER
Credential: MD
Phone: 315-492-5791