Healthcare Provider Details

I. General information

NPI: 1689615395
Provider Name (Legal Business Name): INDEPENDENT PHYSICIANS URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 GENESEE ST
UTICA NY
13502-5662
US

IV. Provider business mailing address

PO BOX 8150
UTICA NY
13505-8150
US

V. Phone/Fax

Practice location:
  • Phone: 315-793-8856
  • Fax: 315-793-8307
Mailing address:
  • Phone: 315-793-8856
  • Fax: 315-793-8307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number093023
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number140042
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number157472
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number171805
License Number StateNY

VIII. Authorized Official

Name: DR. DOMENIC P AIELLO
Title or Position: OWNER
Credential: M.D.
Phone: 315-793-8856