Basic Information
| Provider Information | |||||||||
| NPI: | 1861089146 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RONDENELLI | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 LUECK LN | ||||||||
| Address2: | |||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130886115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152729361 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3504 W GENESEE ST STE 1B | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132192012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154010754 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2020 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | F346529-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.