Healthcare Provider Details

I. General information

NPI: 1073999769
Provider Name (Legal Business Name): CARLY HORNIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE SUITE 530
SYRACUSE NY
13210-1663
US

IV. Provider business mailing address

739 IRVING AVE SUITE 530
SYRACUSE NY
13210-1663
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-1158
  • Fax: 315-478-3014
Mailing address:
  • Phone: 315-478-1158
  • Fax: 315-478-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT209866
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number299132
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: