Riddell, Jonathan Van Buren

Riddell, Jonathan Van Buren is an individual health care provider with primary practice located at 750 E Adams St , Syracuse NY 13210-2342. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Urology, Allopathic & Osteopathic Physicians / Pediatric Urology. Allopathic & Osteopathic Physicians / Pediatric Urology is his primary health care specialty. Riddell, Jonathan Van Buren can be contacted via phone (315) 464-6106.

Contact Information

Primary practice address
750 E Adams St Syracuse NY 13210-2342
Phone: (315) 464-6106
Fax: (315) 464-6107
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Urology 208800000X 270264 New York
Allopathic & Osteopathic Physicians / Pediatric Urology 2088P0231X 270264 New York

Profile Details

NPI number 1922391077
LBN Legal business name Riddell, Jonathan Van Buren
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2011
Last updated Jul 19th, 2013 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922391077 NPPES
New York MEDICAID 03340452

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