Healthcare Provider Details

I. General information

NPI: 1114997509
Provider Name (Legal Business Name): ROBIN S MAURER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 N MAIN ST STE 200A
N SYRACUSE NY
13212-1644
US

IV. Provider business mailing address

1001 W FAYETTE ST STE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-8700
  • Fax: 315-452-0411
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-472-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF330216
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: