Healthcare Provider Details

I. General information

NPI: 1366446262
Provider Name (Legal Business Name): SCOTT M REIZUN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 05/16/2020
Certification Date: 05/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

PO BOX 2005
EAST SYRACUSE NY
13057-4505
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5522
  • Fax:
Mailing address:
  • Phone: 315-449-0513
  • Fax: 315-445-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number173287
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number173287
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: