=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467538991
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYRACUSE GASTROENTEROLOGICAL ASSOCIATES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 07/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 EATON ST SUITE 101
-----------------------------------------------------
City | HAMILTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13346-1124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-234-4818
-----------------------------------------------------
Fax | 315-234-4807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5000 CAMPUSWOOD DR STE 200
-----------------------------------------------------
City | EAST SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13057-1268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-234-4818
-----------------------------------------------------
Fax | 315-234-4807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MARK H KASOWITZ
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 315-234-4818
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------