=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497761431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUZAMIE JO FARNSWORTH DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 03/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 COULTER ROAD
-----------------------------------------------------
City | CLIFTON SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-462-0486
-----------------------------------------------------
Fax | 315-462-2487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 COULTER ROAD CLIFTON SPRINGS HOSP CLIN ATTN MEDICAL STAFF OFFICE
-----------------------------------------------------
City | CLIFTON SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-462-0486
-----------------------------------------------------
Fax | 315-462-2487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 220866
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 220866
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------