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General NPI Number Information
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NPI Number | 1245210129
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Entity Type | Individual
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Provider Name | BENJAMIN I CONNOR R-PA
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Gender | Male
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Dates
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Enumeration Date | 01/18/2006
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Last Update Date | 11/15/2011
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Provider Practice Location Address
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Address Line | 2700 COURT ST
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City | SYRACUSE
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State | NY
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Zip | 13208-3295
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Country | US
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Telephone | 315-455-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 2700 COURT ST
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City | SYRACUSE
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State | NY
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Zip | 13208-3295
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Country | US
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Telephone | 315-455-7610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 011039-1
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License Number State | NY
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