Healthcare Provider Details

I. General information

NPI: 1598963134
Provider Name (Legal Business Name): LATRICE V BELFON-KORNYOH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 S SALINA ST
SYRACUSE NY
13202-3527
US

IV. Provider business mailing address

819 S SALINA ST
SYRACUSE NY
13202-3527
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-7921
  • Fax: 315-475-1448
Mailing address:
  • Phone: 315-476-7921
  • Fax: 315-475-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number244245
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number244245
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: