Provider Demographics
NPI:1467448951
Name:ROME SURGICAL GROUP LLC
Entity type:Organization
Organization Name:ROME SURGICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BULAWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-337-0202
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4503
Mailing Address - Country:US
Mailing Address - Phone:315-446-3904
Mailing Address - Fax:315-445-2936
Practice Address - Street 1:7900 TURIN RD
Practice Address - Street 2:BLDG 2 SUITE 3
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-1900
Practice Address - Country:US
Practice Address - Phone:315-337-0202
Practice Address - Fax:315-337-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01976787Medicaid
NY01976787Medicaid
AA0395Medicare ID - Type Unspecified