Healthcare Provider Details

I. General information

NPI: 1265141790
Provider Name (Legal Business Name): JAMES THOMAS O'CONNOR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 09/23/2026
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-4363
  • Fax: 315-464-8690
Mailing address:
  • Phone: 315-464-4363
  • Fax: 315-464-8690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-13093
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number036341
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: