Healthcare Provider Details

I. General information

NPI: 1578557583
Provider Name (Legal Business Name): COMMUNITY GENERAL HOSPITAL OF GREATER SYRACUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

IV. Provider business mailing address

4900 BROAD RD
SYRACUSE NY
13215-2265
US

V. Phone/Fax

Practice location:
  • Phone: 315-492-5554
  • Fax: 315-492-5071
Mailing address:
  • Phone: 315-492-5554
  • Fax: 315-492-5071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA E JOHNSON
Title or Position: CORPORATE VP OF FINANCES CFO
Credential:
Phone: 315-492-5731