Fairway Management, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

33D2071872 Issued in NY

Legal business name

FAIRWAY MANAGEMENT, LLC

Doing business as

inDeed Wellness

Practice address

240 W Seneca St
Suite 8
Manlius, NY 13104-3401

Phone

(315) 682-0328

Fax

(315) 682-0295

NPI assigned

Aug 5, 2014

Last updated

Aug 5, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robert Eugene Bailey, MD

Title

Medical Director

Phone

(315) 682-0325

Specialties & licenses 1

Addresses

Other names 1

• inDeed Wellness Doing business as

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

{
    "created_epoch": "1407196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407196800000",
    "number": "1033528948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W SENECA ST",
            "address_2": "SUITE 8",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131043401",
            "telephone_number": "315-682-0328",
            "fax_number": "315-682-0295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W SENECA ST",
            "address_2": "SUITE 8",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131043401",
            "telephone_number": "315-682-0328",
            "fax_number": "315-682-0295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRWAY MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-05",
        "last_updated": "2014-08-05",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "315-682-0325",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NY",
            "license": "33D2071872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "inDeed Wellness",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peter H Emery Jr., RPH
• Patricia D Endy, RD
• Charlotte Giovanna Ennis, DPT
• Mark Steven Erlebacher, M.D.
• Fairgrounds Family Physicians PLLC
• Fayetteville Manlius School District
• Fayetteville-Manlius Oral Surgery, P.C
• Adam Feck
• Karen Fernandez-Cosgrove, PH.D., LMFT
• Jessica M Fetterman, PA

• Clinical Medical Laboratory in Manlius, NY
• Providers in Manlius, NY by specialty
• Clinical Medical Laboratory in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.