Healthcare Provider Details

I. General information

NPI: 1710254602
Provider Name (Legal Business Name): SUNY UPSTATE UNIVERSITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2342
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2342
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5234
  • Fax:
Mailing address:
  • Phone: 315-464-5234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number033587
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number033587
License Number StateNY

VIII. Authorized Official

Name: MRS. ANGELA MICHELLE FRANK
Title or Position: PHYSICAL THERAPIST
Credential: M.S.P.T
Phone: 512-644-1180