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General NPI Number Information
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NPI Number | 1730248022
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Entity Type | Organization
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Legal Business Name | COLON RECTAL ASSOCIATES OF CENTRAL NEW YORK, LLP
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | GLACIER CREEK OFFICE PARK - BLDG II 6711 TOWPATH RD., SUITE 175
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9510
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Country | US
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Telephone | 315-458-2211
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Fax | 315-452-9025
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Provider Business Mailing Address
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Address Line | GLACIER CREEK OFFICE PARK - BLDG II 6711 TOWPATH RD., SUITE 175
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9510
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Country | US
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Telephone | 315-458-2211
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Fax | 315-452-9025
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN D. NICHOLSON
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Credential | MD
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Telephone | 315-458-2211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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