Healthcare Provider Details

I. General information

NPI: 1073650248
Provider Name (Legal Business Name): INTEGRATED MEDICINE OF SYRACUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4583 NORTH ST
JAMESVILLE NY
13078-9461
US

IV. Provider business mailing address

4583 NORTH ST
JAMESVILLE NY
13078-9461
US

V. Phone/Fax

Practice location:
  • Phone: 315-378-0071
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID SUSSMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 315-378-0071