MEDICARE: JENNIFER C MARZIALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	222477	NY

General Provider Information

NPI Number	:	1578566436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER C MARZIALE MD

Provider Business Mailing Address
First Line	:	4850 BROAD RD
Second Line	:	STE 2C
City	:	SYRACUSE
State	:	NY
Zip	:	13215-5103
Country	:	US
Telephone Number	:	315-492-5915
Fax Number	:	315-492-5210

Provider Business Practice Location Address
First Line	:	4850 BROAD RD
Second Line	:	STE 2C
City	:	SYRACUSE
State	:	NY
Zip	:	13215-5103
Country	:	US
Telephone Number	:	315-492-5915
Fax Number	:	315-492-5210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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