Healthcare Provider Details

I. General information

NPI: 1831192806
Provider Name (Legal Business Name): MARIA I PASNICIUC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5794 WIDEWATERS PKWY
SYRACUSE NY
13214
US

IV. Provider business mailing address

5794 WIDEWATERS PKWY
SYRACUSE NY
13214-1845
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-1513
  • Fax: 315-422-5890
Mailing address:
  • Phone: 315-422-1513
  • Fax: 315-422-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number263096-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: