Basic Information
| Provider Information | |||||||||
| NPI: | 1578654828 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOHAWK VALLEY SURGERY GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157337798 | ||||||||
| FaxNumber: | 3157337893 | ||||||||
| Practice Location | |||||||||
| Address1: | 2211 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 135015930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157337798 | ||||||||
| FaxNumber: | 3157337893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 01/03/2013 | ||||||||
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| AuthorizedOfficialLastName: | EL-AMIR | ||||||||
| AuthorizedOfficialFirstName: | NABEEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRES. | ||||||||
| AuthorizedOfficialTelephone: | 3157337798 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 190295-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 203719-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 162144-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 11616-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 174400000X | 183436 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist | 363A00000X | 007138-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 009013-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 010940-1 | NY | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 174400000X | 196623-1 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.