Provider Demographics
NPI:1699071373
Name:ONEIDA MEDICAL PRACTICE, PC
Entity type:Organization
Organization Name:ONEIDA MEDICAL PRACTICE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-697-2033
Mailing Address - Street 1:301 GENESEE ST - SUITE C
Mailing Address - Street 2:ATTN: NEUROLOGY SPECIALISTS OF ONEIDA
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2611
Mailing Address - Country:US
Mailing Address - Phone:315-361-2377
Mailing Address - Fax:315-361-2978
Practice Address - Street 1:301 GENESEE ST - SUITE C
Practice Address - Street 2:ATTN: NEUROLOGY SPECIALISTS OF ONEIDA
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2611
Practice Address - Country:US
Practice Address - Phone:315-361-2377
Practice Address - Fax:315-361-2978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ONEIDA MEDICAL PRACTICE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-28
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2534062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03357884Medicaid