NPIMap

Organization Active NPI

Upstate Urology, Inc.

  • Urology Physician
  • Syracuse, NY
National Provider Identifier
1003062043
Registry record updated Jul 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
UPSTATE UROLOGY, INC.
Practice address
750 E Adams St
Syracuse, NY 13210-2342
Phone
(315) 464-6106
Fax
(315) 464-6117
NPI assigned
Aug 11, 2008
Last updated
Jul 28, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gennady Bratslavsky, MDNPI 1508093121
Title
Chair
Phone
(315) 464-6106

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X NY Primary

Addresses

Primary practice location

750 E Adams St
Syracuse, NY 13210-2342

Mailing address

750 E Adams St
Syracuse, NY 13210-2342
Phone (315) 464-6106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081212000084 NY Part B Supplier - Clinic/Group Practice 1254492952 Receives reassigned benefits from 42 practitioners
Practice locations: Camillus, NY; Syracuse, NY; Verona, NY

National Provider Directory

National Provider Directory

Locations

208 Township Blvd
Ste 300
Camillus, NY 13031
Phone (315) 473-3300

4900 Broad Rd
Ste 4V
Syracuse, NY 13215
Phone (315) 492-3700

550 Harrison St
Ste 300
Syracuse, NY 13202
Phone (315) 464-1500

725 Irving Ave
Ste 403
Syracuse, NY 13210
Phone (315) 464-6060

Practitioners & affiliated clinicians

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 44

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1218412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311811200000",
    "number": "1003062043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-6106",
            "fax_number": "315-464-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 E ADAMS ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132102342",
            "telephone_number": "315-464-6106",
            "fax_number": "315-464-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UPSTATE UROLOGY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-11",
        "last_updated": "2011-07-28",
        "status": "A",
        "authorized_official_last_name": "BRATSLAVSKY",
        "authorized_official_first_name": "GENNADY",
        "authorized_official_title_or_position": "CHAIR",
        "authorized_official_telephone_number": "315-464-6106",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "NY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Syracuse, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.