1386990638

Everything you always wanted to know about CROUSE MEDICAL PRACTICE PLLC 5 SPORTS CARE EXPRESS KRONENBERG PAUL but were afraid to ask.

CROUSE MEDICAL PRACTICE PLLC 5 SPORTS CARE EXPRESS KRONENBERG PAUL

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Organization Name Other Organization Name Type Code Other Organization Name Authorized Official Last Name Authorized Official First Name
CROUSE MEDICAL PRACTICE PLLC 5 SPORTS CARE EXPRESS KRONENBERG PAUL
Gender:
none
Enumeration date:
2012-07-24
Last update date:
2012-07-24
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No

Identifiers

identifier description issuer state
<UNAVAIL> Parent Organization TIN
<UNAVAIL> Parent Organization TIN

Taxonomies

Taxonomy State License Number Primary?
204E00000X Oral & Maxillofacial Surgery none none
363LW0102X Women's Health none none

Phone Numbers

Type Number
Mailing Address Telephone Number 3154463904
Authorized Official Telephone Number 3154707825
Mailing Address Fax Number 3155526590
Practice Location Address Telephone Number 3154746824

Addresses

Type Address City State Postal Country
Mailing Address PO BOX 91004 ROCHESTER NY 14692 NY
Practice Location Address 5823 WIDEWATERS PKWY EAST SYRACUSE NY 13057 NY

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1609865054 AESTHETIC PLASTIC SURGERY OF S
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1710954276 MANTA, OANA
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1780672378 MALDONADO, BRINA
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Organization
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475 IRVING AVE NY SYRACUSE

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NPI Name Address State City
1083024327 RUSSO, MARK
Individual
5823 WIDEWATERS PKWY NY EAST SYRACUSE
1104925833 MELFI, RENEE
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5823 WIDEWATERS PKWY NY EAST SYRACUSE
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1194270066 TEMPLAR, JACOB
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Individual
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Organization
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