Agcny Physicians PLLC
Organization Active NPI Anesthesiology Physician · Fayetteville, NY
NPI 1033497136 · NPPES record last updated Jul 25, 2011
Key facts
- NPI
- 1033497136
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- Legal business name
- AGCNY PHYSICIANS PLLC
- Practice address
- 4309 Medical Center Dr
Fayetteville, NY 13066-6638 - Phone
- (315) 329-7300
- Fax
- (315) 329-7308
- NPI assigned
- Jul 25, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. John Dale, MD
- Title
- Owner
- Phone
- (315) 492-5292
Member of 2
Practitioners 76
-
Leah R Andonian, DO
-
Jacob Carl Beer, DO
-
Tatyana V Didenko, CRNA
-
Sean Dunn, CRNA
-
Jeffrey Alan Gaulrapp, CRNA
-
Marina Elizabeth Grabda, CRNA
-
Philip Ingrassia, CRNA
-
David Oommen Joseph, M.D.
-
Timothy E McCall, MD
-
Therese F Oliver, CRNA
-
Jenifer E Orico, CRNA
-
Michael Joseph Pereira III, DNP CRNA
-
Grace M Powers, CRNA
-
Erik Quilty, M.D.
-
Kyle F Riley, CRNA
-
Ryan Christopher Staib, DNP, CRNA
-
Diego Villamizar, M.D.
-
Timothy J Walker, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110826000658 | NY | Part B Supplier - Clinic/Group Practice | 4284804345 |
Receives reassigned benefits from 73 practitioners Practice locations: Camillus, NY; Fayetteville, NY |
National Provider Directory
Locations
260 Township Blvd
Ste 20
Camillus, NY 13031
Phone (315) 708-0091
4309 Medical Center Dr
Ste 308
Fayetteville, NY 13066
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes |
Addresses
Primary practice location
4309 Medical Center Dr
Fayetteville, NY 13066-6638
Mailing address
PO Box 2000
East Syracuse, NY 13057-4500
Phone (315) 449-0513
Other providers in Fayetteville, NY
- Katherine Abbey
- Fadi Nabil Abdallah
- Ancy A. Abraham
- Agcny East LLC
- Janette S Albrecht
- Keith Alan Alexander
- Alexis James Virtual Counseling
- Maureen Ann Aliani
- Mary Lily Allen
All providers in Fayetteville, NY · Anesthesiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 25, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.