Provider Demographics
NPI:1528297371
Name:BELANGER, EVAN HARRIS (FNP, RNFA)
Entity type:Individual
Prefix:MR
First Name:EVAN
Middle Name:HARRIS
Last Name:BELANGER
Suffix:
Gender:M
Credentials:FNP, RNFA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-475-3999
Mailing Address - Fax:315-470-4014
Practice Address - Street 1:739 IRVING AVE STE 600
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1663
Practice Address - Country:US
Practice Address - Phone:315-701-2550
Practice Address - Fax:315-701-2551
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335951-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03210684Medicaid
NYJ400031915Medicare UPIN