Healthcare Provider Details

I. General information

NPI: 1225052772
Provider Name (Legal Business Name): DEPARTMENT OF MEDICINE MEDICAL SERVICE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E GENESEE ST SUITE 403
SYRACUSE NY
13210-1892
US

IV. Provider business mailing address

1000 E GENESEE ST SUITE 403
SYRACUSE NY
13210-1892
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-2929
  • Fax: 315-464-2930
Mailing address:
  • Phone: 315-464-2929
  • Fax: 315-464-2930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name: MICHAEL C. IANNUZZI
Title or Position: PRESIDENT
Credential: MD
Phone: 315-464-3835