=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225253271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEONATAL ASSOCIATES OF CENTRAL NEW YORK PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2007
-----------------------------------------------------
Last Update Date | 07/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 736 IRVING AVE STE 9100
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-470-7379
-----------------------------------------------------
Fax | 315-470-2923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 736 IRVING AVE STE 9100
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210-1687
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-470-7379
-----------------------------------------------------
Fax | 315-470-2923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. BOURA'A BOU ARAM
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 315-470-7379
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080N0001X
-----------------------------------------------------
Taxonomy Name | Neonatal-Perinatal Medicine Physician
-----------------------------------------------------
License Number | 126383
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------