Healthcare Provider Details

I. General information

NPI: 1316030950
Provider Name (Legal Business Name): JEFFREY F SIRACUSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 HICKS ST PEDIATRICS / NEONATOLOGY
BROOKLYN NY
11201-5509
US

IV. Provider business mailing address

160 WATER ST 20TH FLOOR
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-1832
  • Fax:
Mailing address:
  • Phone: 212-256-3682
  • Fax: 212-256-3538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number142850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: