Healthcare Provider Details

I. General information

NPI: 1972595908
Provider Name (Legal Business Name): FINGER LAKES ANESTHESIA GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E MARKET ST
ELMIRA NY
14901-3223
US

IV. Provider business mailing address

PO BOX 2005
EAST SYRACUSE NY
13057-4505
US

V. Phone/Fax

Practice location:
  • Phone: 607-733-6541
  • Fax: 607-737-1514
Mailing address:
  • Phone: 315-449-0513
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN REED
Title or Position: PRESIDENT
Credential: MD
Phone: 607-737-7831