Healthcare Provider Details

I. General information

NPI: 1255854170
Provider Name (Legal Business Name): JEFFREY MICHAEL EMLAW LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 GATEWAY PARK DR BLDG B
SYRACUSE NY
13212-3760
US

IV. Provider business mailing address

1401 CLAYTON MANOR DR APT 12
LIVERPOOL NY
13088-5372
US

V. Phone/Fax

Practice location:
  • Phone: 315-491-7000
  • Fax:
Mailing address:
  • Phone: 315-935-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP142067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: