Healthcare Provider Details

I. General information

NPI: 1568573061
Provider Name (Legal Business Name): ANIS I OBEID MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

PO BOX 2337
SYRACUSE NY
13220-2337
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7370
  • Fax: 315-470-2776
Mailing address:
  • Phone: 315-422-2933
  • Fax: 315-422-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ANIS OBIED
Title or Position: PRESIDENT
Credential: MD
Phone: 315-470-7273