Healthcare Provider Details

I. General information

NPI: 1659086833
Provider Name (Legal Business Name): FUNDA E SUER PHD, FACMG, DABMGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 IRVING AVE
SYRACUSE NY
13210-1718
US

IV. Provider business mailing address

505 IRVING AVE
SYRACUSE NY
13210-1718
US

V. Phone/Fax

Practice location:
  • Phone: 866-240-4485
  • Fax:
Mailing address:
  • Phone: 866-240-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0203X
TaxonomyClinical Molecular Genetics Physician
License NumberORKUF1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: