Provider Demographics
NPI:1881734739
Name:SURGICAL ASSOCIATES OF UPSTATE NEW YORK, LLP
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF UPSTATE NEW YORK, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:OVID
Authorized Official - Middle Name:O
Authorized Official - Last Name:NEULANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-488-5588
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-488-5588
Mailing Address - Fax:315-488-2489
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-488-5588
Practice Address - Fax:315-488-2489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00948213Medicaid
NY00948213Medicaid