Healthcare Provider Details

I. General information

NPI: 1992032429
Provider Name (Legal Business Name): NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6711 TOWPATH RD STE 265
EAST SYRACUSE NY
13057-9510
US

IV. Provider business mailing address

PO BOX 510
SYRACUSE NY
13214-0510
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-3480
  • Fax: 315-703-3481
Mailing address:
  • Phone: 315-703-3480
  • Fax: 315-703-3481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROBERT TISO
Title or Position: DIRECTOR
Credential: MD
Phone: 315-552-6700