Individual
JONATHAN VAN BUREN RIDDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-6106
(315) 464-6107
Mailing address
750 E ADAMS ST, SYRACUSE, NY 13210-2342
(315) 464-6106
(315) 464-6107
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
270264
NY
2088P0231X
Pediatric Urology Physician
Primary
270264
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03340452
—
NY
Enumeration date
05/24/2011
Last updated
07/19/2013
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