Provider Demographics
NPI:1831276823
Name:NEPHROLOGY ASSOCIATES OF SYRACUSE, P.C.
Entity type:Organization
Organization Name:NEPHROLOGY ASSOCIATES OF SYRACUSE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:T
Authorized Official - Last Name:ONDOCIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-478-3311
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:315-552-6590
Practice Address - Street 1:1304 BUCKLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4301
Practice Address - Country:US
Practice Address - Phone:315-478-3311
Practice Address - Fax:315-214-4847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00581631Medicaid
NY20000510941OtherMVP
NYCF7820OtherRR MEDICARE
NY20000510941OtherMVP