NPIMap

Organization Active NPI

Agcny Physicians PLLC

  • Anesthesiology Physician
  • Fayetteville, NY
National Provider Identifier
1033497136
Registry record updated Jul 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 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
Last updated
Jul 25, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2011

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

Authorized official

Name
Dr. John Dale, MD
Title
Owner
Phone
(315) 492-5292

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110826000658 NY Part B Supplier - Clinic/Group Practice 4284804345 Receives reassigned benefits from 73 practitioners
Practice locations: Camillus, NY; Fayetteville, NY

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

260 Township Blvd
Ste 20
Camillus, NY 13031
Phone (315) 708-0091

Practitioners & affiliated clinicians

Practitioners 76

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 76

NPI Registry JSON

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311552000000",
    "number": "1033497136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2000",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574500",
            "telephone_number": "315-449-0513",
            "fax_number": "311-544-5293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 MEDICAL CENTER DR",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666638",
            "telephone_number": "315-329-7300",
            "fax_number": "315-329-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGCNY PHYSICIANS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-25",
        "last_updated": "2011-07-25",
        "status": "A",
        "authorized_official_last_name": "DALE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-492-5292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 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.