Provider Demographics
NPI:1447476254
Name:MINIMALLY INVASIVE SURGERY OF OSWEGO COUNTY, PLLC
Entity type:Organization
Organization Name:MINIMALLY INVASIVE SURGERY OF OSWEGO COUNTY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MINIMALLY INVASIVE SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-342-3400
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:140 WEST SIXTH STREET SUITE 270
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-0196
Mailing Address - Country:US
Mailing Address - Phone:315-342-3400
Mailing Address - Fax:
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:SUITE 270
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2525
Practice Address - Country:US
Practice Address - Phone:315-342-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234085174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000925084001OtherHEALTHNOW
NY5954225OtherAETNA
NY376629OtherMVP
NY01339211-046Medicaid
NY5954225OtherAETNA
NYC38809Medicare UPIN