Healthcare Provider Details

I. General information

NPI: 1942299219
Provider Name (Legal Business Name): CRITICAL CARE ASSOCIATES OF SYRACUSE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

PO BOX 2004
EAST SYRACUSE NY
13057-4504
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7186
  • Fax: 315-470-2990
Mailing address:
  • Phone: 315-446-3904
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL ACEVEDO
Title or Position: PRESIDENT
Credential: MD
Phone: 315-470-7186