Organization
ASSOCIATED GASTROENTEROLOGISTS OF CENTRAL NEW YORK, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL GALLUP (CREDENTIALING COORDINATOR)
(315) 218-0085
Entity
Organization
Contact information
Practice address
260 TOWNSHIP BLVD, STE 20, CAMILLUS, NY 13031
(315) 708-0190
(315) 488-3284
Mailing address
260 TOWNSHIP BLVD, STE 20, CAMILLUS, NY 13031
(315) 708-0091
(315) 708-0194
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00482137
—
NY
01
—
CC7979
R/R MEDICARE
NY
01
—
CF1049
R/R MEDICARE
NY
Enumeration date
07/22/2006
Last updated
03/17/2018
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