1023497203 NPI number — NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023497203 NPI number — NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023497203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYRACUSE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13214-0510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-703-3480
Provider Business Mailing Address Fax Number:
315-703-3481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5417 WEST GENESEE STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CAMILLUS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-432-4900
Provider Business Practice Location Address Fax Number:
315-488-2397
Provider Enumeration Date:
05/21/2015

Additional Information

Authorized Official

Authorized Official Last Name:
TISO
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
315-552-6700

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 03423585 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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