Healthcare Provider Details

I. General information

NPI: 1396820825
Provider Name (Legal Business Name): ANIL K. VERMA, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 ERIE BLVD E
SYRACUSE NY
13210-1230
US

IV. Provider business mailing address

1816 ERIE BLVD E
SYRACUSE NY
13210-1230
US

V. Phone/Fax

Practice location:
  • Phone: 315-214-0390
  • Fax: 315-214-0398
Mailing address:
  • Phone: 315-214-0390
  • Fax: 315-214-0398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number172632
License Number StateNY

VIII. Authorized Official

Name: DR. ANIL K VERMA
Title or Position: OWNER OF THE GROUP
Credential: M.D.
Phone: 315-214-0390