Healthcare Provider Details

I. General information

NPI: 1467448951
Provider Name (Legal Business Name): ROME SURGICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 TURIN RD BLDG 2 SUITE 3
ROME NY
13440-1900
US

IV. Provider business mailing address

PO BOX 2003
EAST SYRACUSE NY
13057-4503
US

V. Phone/Fax

Practice location:
  • Phone: 315-337-0202
  • Fax: 315-337-8188
Mailing address:
  • Phone: 315-446-3904
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BETH A BULAWA
Title or Position: PARTNER
Credential: MD
Phone: 315-337-0202