Organization
PLASTIC & RECONSTRUCTIVE SURGERY OF CNY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY A BIDWELL (BILLING SUPERVISOR)
(315) 752-0141
Entity
Organization
Contact information
Practice address
475 IRVING AVE, SUITE 320, SYRACUSE, NY 13210-1756
(315) 425-7822
(315) 425-7885
Mailing address
6221 STATE ROUTE 31, SUITE 104, CICERO, NY 13039-8724
(315) 752-0141
(315) 752-0142
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
124408
NY
208200000X
Plastic Surgery Physician
145420
NY
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
124408
NY
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
145420
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01019447
—
NY
Enumeration date
11/17/2006
Last updated
01/29/2015
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