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General NPI Number Information
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NPI Number | 1396934923
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Entity Type | Organization
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Legal Business Name | FINGER LAKES PSYCHIATRIC ASSOCIATES, PC
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/31/2015
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Provider Practice Location Address
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Address Line | 4900 BROAD RD
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City | SYRACUSE
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State | NY
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Zip | 13215-2265
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Country | US
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Telephone | 315-492-5635
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Fax |
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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 | 315-422-6548
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MUSLIM KHAN
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Credential | MD
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Telephone | 315-492-5635
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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