Healthcare Provider Details

I. General information

NPI: 1760423347
Provider Name (Legal Business Name): ROBERTO E IZQUIERDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E. ADAMS STREET 5TH FL
SYRACUSE NY
13210
US

IV. Provider business mailing address

725 E. ADAMS STREET 5TH FL
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5726
  • Fax: 315-464-2500
Mailing address:
  • Phone: 315-464-5726
  • Fax: 315-464-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number183878
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: