NPIMap

Organization Active NPI

Suny Upstate

  • Clinic/Center
  • Syracuse, NY
National Provider Identifier
1053789610
Registry record updated Sep 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
F339820-1 Issued in NY
Legal business name
SUNY UPSTATE
Practice address
90 Presidential PLZ
Syracuse, NY 13202-2240
Phone
(315) 464-3833
NPI assigned
Sep 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2015

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

Authorized official

Name
Mrs. Viktoria Kenney, FNPNPI 1699144527
Title
FNP
Phone
(607) 759-7462

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
Clinic/Center 261Q00000X F339820-1 NY Primary

Addresses

Primary practice location

90 Presidential PLZ
Syracuse, NY 13202-2240

Mailing address

5104 Waterford Wood Way
Fayetteville, NY 13066-9799
Phone (607) 759-7462

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1441929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441929600000",
    "number": "1053789610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5104 WATERFORD WOOD WAY",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130669799",
            "telephone_number": "607-759-7462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 PRESIDENTIAL PLZ",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132022240",
            "telephone_number": "315-464-3833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNY UPSTATE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-11",
        "last_updated": "2015-09-11",
        "status": "A",
        "authorized_official_last_name": "KENNEY",
        "authorized_official_first_name": "VIKTORIA",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "607-759-7462",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NY",
            "license": "F339820-1",
            "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 Sep 11, 2015; 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.