Organization
UPSTATE UROLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GENNADY BRATSLAVSKY MD (CHAIR)
(315) 464-6106
Entity
Organization
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-6106
(315) 464-6117
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-6106
(315) 464-6117
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03043809
—
NY
Enumeration date
08/11/2008
Last updated
07/28/2011
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