Individual
NATHAN DEFORGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 IRVING AVE, SYRACUSE, NY 13210-2716
(315) 425-4400
Mailing address
5952 LADD RD, BREWERTON, NY 13029-9642
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
882332-01
NY
Other
Enumeration date
09/15/2025
Last updated
09/15/2025
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