Healthcare Provider Details

I. General information

NPI: 1649435025
Provider Name (Legal Business Name): FNU SEEMANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 TAUGHANNOCK BLVD
ITHACA NY
14850-3251
US

IV. Provider business mailing address

121 SIMSBURY DR
ITHACA NY
14850-1728
US

V. Phone/Fax

Practice location:
  • Phone: 607-252-3580
  • Fax:
Mailing address:
  • Phone: 216-501-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number277133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: