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General NPI Number Information
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NPI Number | 1427282771
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Entity Type | Organization
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Legal Business Name | UPSTATE ORTHOPEDICS AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 05/05/2022
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Provider Practice Location Address
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Address Line | 6620 FLY ROAD SUITE 300
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City | EAST SYRACUSE
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State | NY
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Zip | 13057
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Country | US
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Telephone | 315-432-5960
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Fax | 315-432-5979
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Provider Business Mailing Address
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Address Line | 6620 FLY ROAD SUITE 300
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City | EAST SYRACUSE
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State | NY
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Zip | 13057
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Country | US
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Telephone | 315-432-5960
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Fax | 315-432-5979
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JON DAVID VAN VALKENBURG
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Credential |
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Telephone | 315-432-5971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 3321200R
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License Number State | NY
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