Healthcare Provider Details

I. General information

NPI: 1669469912
Provider Name (Legal Business Name): SANJEEV KUMAR VERMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S 4TH ST AL LEE MEMORIAL HOSPITAL
FULTON NY
13069-2904
US

IV. Provider business mailing address

2316 JAMES ST
SYRACUSE NY
13206-2839
US

V. Phone/Fax

Practice location:
  • Phone: 315-591-9400
  • Fax:
Mailing address:
  • Phone: 315-463-5107
  • Fax: 315-463-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number186598
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number186598
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number186598
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number186598
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: