Healthcare Provider Details

I. General information

NPI: 1497761431
Provider Name (Legal Business Name): SUZAMIE JO FARNSWORTH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/21/2023
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER ROAD
CLIFTON SPRINGS NY
14432
US

IV. Provider business mailing address

2 COULTER ROAD CLIFTON SPRINGS HOSP CLIN ATTN MEDICAL STAFF OFFICE
CLIFTON SPRINGS NY
14432
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-0486
  • Fax: 315-462-2487
Mailing address:
  • Phone: 315-462-0486
  • Fax: 315-462-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number220866
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number220866
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: