Healthcare Provider Details

I. General information

NPI: 1922337195
Provider Name (Legal Business Name): UPSTATE UNIVERSITY RADIATION ONCOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST # 1064
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST # 1064
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-2020
  • Fax: 315-464-2025
Mailing address:
  • Phone: 315-464-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY BUCKMAN
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 315-464-2020