Healthcare Provider Details

I. General information

NPI: 1568571834
Provider Name (Legal Business Name): SOUTHERN NEW YORK NEUROSURGICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 FRONT ST
VESTAL NY
13850-1559
US

IV. Provider business mailing address

200 FRONT ST
VESTAL NY
13850-1559
US

V. Phone/Fax

Practice location:
  • Phone: 607-748-7468
  • Fax: 607-754-6130
Mailing address:
  • Phone: 607-748-7468
  • Fax: 607-754-6130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID KAMMERMAN
Title or Position: PAIN SPECIALIST
Credential: M.D.
Phone: 607-748-7468