Healthcare Provider Details

I. General information

NPI: 1205259611
Provider Name (Legal Business Name): NY URGENT CARE PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 04/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3504 W GENESEE ST STE 1B
SYRACUSE NY
13219-2008
US

IV. Provider business mailing address

PO BOX 500
ELLICOTTVILLE NY
14731-0500
US

V. Phone/Fax

Practice location:
  • Phone: 315-401-0754
  • Fax: 315-401-0755
Mailing address:
  • Phone: 716-699-9032
  • Fax: 716-699-9035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN C RADFORD
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 716-699-9032