Provider Demographics
NPI:1063434975
Name:INFECTIOUS DISEASE ASSOCIATES LLP
Entity type:Organization
Organization Name:INFECTIOUS DISEASE ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRAMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-624-6000
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:NEW YORK MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13417-0060
Mailing Address - Country:US
Mailing Address - Phone:315-736-2080
Mailing Address - Fax:315-736-2162
Practice Address - Street 1:587 MAIN ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK MILLS
Practice Address - State:NY
Practice Address - Zip Code:13417-1481
Practice Address - Country:US
Practice Address - Phone:315-624-6000
Practice Address - Fax:315-624-4720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143133207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02319331Medicaid
NY02319331Medicaid