Healthcare Provider Details

I. General information

NPI: 1639199441
Provider Name (Legal Business Name): DEPARTMENT OF MEDICINE MEDICAL SERV GRP AT SUNY HLTH SCI CTR AT SYR IN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 IRVING AVE SUITE 311
SYRACUSE NY
13210-1603
US

IV. Provider business mailing address

725 IRVING AVE SUITE 311
SYRACUSE NY
13210-1603
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5533
  • Fax: 315-464-5579
Mailing address:
  • Phone: 315-464-5533
  • Fax: 315-464-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNY

VIII. Authorized Official

Name: SRIRAM NARSIPUR
Title or Position: PRESIDENT
Credential: MD
Phone: 315-464-3834