Healthcare Provider Details

I. General information

NPI: 1982813424
Provider Name (Legal Business Name): COMPREHENSIVE GYNECOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 JAMES ST STE 100B
SYRACUSE NY
13203-2642
US

IV. Provider business mailing address

770 JAMES ST STE 100B
SYRACUSE NY
13203-2642
US

V. Phone/Fax

Practice location:
  • Phone: 315-423-4222
  • Fax: 315-423-0305
Mailing address:
  • Phone: 315-423-4222
  • Fax: 315-423-0305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number161388
License Number StateNY

VIII. Authorized Official

Name: DR. MARK DAVID ADELSON
Title or Position: OWNER
Credential: MD
Phone: 315-423-4222