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Organization

UPSTATE MEDICAL CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. KEVIN IMMARRI HICKMAN CRNA (NURSE ANESTHETIST)
(917) 579-8187
Entity
Organization

Contact information

Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-5654
Mailing address
7I CREEKSIDE VLG, BUFFALO, NY 14261-0040
(917) 579-8187

Taxonomy

Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary

Other

Enumeration date
02/09/2011
Last updated
02/09/2011
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