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General NPI Number Information
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NPI Number | 1154584688
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Entity Type | Organization
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Legal Business Name | UPSTATE UNIVERSITY HOSPITAL
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Dates
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Enumeration Date | 07/03/2008
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Last Update Date | 07/03/2008
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2342
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Country | US
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Telephone | 315-464-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 460 S MAIN ST APT 246
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-3050
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Country | US
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Telephone | 315-450-3567
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Fax |
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Authorized Official
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Title or Position | PRIVATE PHYSICIAN
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Name | DR. RANDA KHAIRALLAH
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Credential |
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Telephone | 315-464-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | NOT YET LICENSED
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License Number State |
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