Healthcare Provider Details

I. General information

NPI: 1457983181
Provider Name (Legal Business Name): SYRACUSE MEDICAL OF NEW YORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 ERIE BLVD E STE 201B
SYRACUSE NY
13210-1144
US

IV. Provider business mailing address

PO BOX 32
NORTHBROOK IL
60065-0032
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-8460
  • Fax:
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-235-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORA KATSNELSON
Title or Position: OWNER
Credential: M.D.
Phone: 224-318-0118