Healthcare Provider Details

I. General information

NPI: 1326721788
Provider Name (Legal Business Name): ROBERT WILLIAM CONNER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1602
US

IV. Provider business mailing address

5770 INNSBRUCK RD
EAST SYRACUSE NY
13057-3059
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7111
  • Fax:
Mailing address:
  • Phone: 717-940-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberF351985-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: