Northway Medical Associates PLLC

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

211928 Issued in NY

Legal business name

NORTHWAY MEDICAL ASSOCIATES PLLC

Practice address

21 N 2ND St
Fulton, NY 13069-1250

Phone

(315) 598-7105

NPI assigned

Feb 6, 2014

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Northway Medical Doing business as

Part of

Tri - State Medical Group Inc

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

{
    "created_epoch": "1391644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391644800000",
    "number": "1356765689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 N 2ND ST",
            "city": "FULTON",
            "state": "NY",
            "postal_code": "130691250",
            "telephone_number": "315-598-7105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWAY MEDICAL ASSOCIATES PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2014-02-06",
        "last_updated": "2014-02-06",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "NY",
            "license": "211928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northway Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debra Marie Naioti, LPN
• Mary Nateo
• Thuy VI T Nguyen, PHARMD
• Patrick J. Nicholson, D.C.
• Northern Oswego County Health Services, Inc.
• Northway Medical Associates, PLLC
• Nu-Ops, Inc
• Shawnna Ann Nye, MSN, FNP-C
• O H Services, Inc.
• Felix Takor Oben, MD

• Non-Pharmacy Dispensing Site in Fulton, NY
• Providers in Fulton, NY by specialty
• Non-Pharmacy Dispensing Site in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 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.