Healthcare Provider Details

I. General information

NPI: 1467659060
Provider Name (Legal Business Name): ASSOCIATED MEDICAL PROFESSIONALS OF NY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 E WATER ST
SYRACUSE NY
13210-1155
US

IV. Provider business mailing address

100 METROPOLITAN PARK DR STE 100
LIVERPOOL NY
13088-7112
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-2887
  • Fax: 315-478-0840
Mailing address:
  • Phone: 315-870-9370
  • Fax: 315-558-6611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELO R DEROSALIA
Title or Position: CEO
Credential: MD
Phone: 315-458-3343