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General NPI Number Information
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NPI Number | 1336194265
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Entity Type | Organization
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Legal Business Name | CNY GASTROENTEROLOGY, PLLC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 77 NELSON ST SUITE 240
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City | AUBURN
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State | NY
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Zip | 13021-1944
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Country | US
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Telephone | 315-252-0810
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Fax | 315-252-5179
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Provider Business Mailing Address
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Address Line | PO BOX 2337
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City | SYRACUSE
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State | NY
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Zip | 13220-2337
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Country | US
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Telephone | 315-422-6705
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Fax | 315-422-3909
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAYEES NIZAM
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Credential | MD
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Telephone | 315-252-0810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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