=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174995658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIDZY B LYSIUS NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2015
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 725 EAST ADAMS STREET
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-464-4842
-----------------------------------------------------
Fax | 315-464-8912
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 SALINA MEADOWS PARKWAY SUITE 100
-----------------------------------------------------
City | SYRACUSE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-464-2000
-----------------------------------------------------
Fax | 315-464-2010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 343225
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 343225
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 685753-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------