Healthcare Provider Details

I. General information

NPI: 1437249612
Provider Name (Legal Business Name): MARIO FRANCIS PANETTA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 E FAYETTE ST
SYRACUSE NY
13210-1022
US

IV. Provider business mailing address

154 NURSERY AVE
GENEVA NY
14456-2559
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4400
  • Fax:
Mailing address:
  • Phone: 315-789-5538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: