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General NPI Number Information
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NPI Number | 1548351935
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Entity Type | Organization
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Legal Business Name | EYE PLASTIC AND RECONSTRUCTIVE SURGERY OF CNY PC
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 3400 VICKERY RD SUITE A
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-4540
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Country | US
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Telephone | 315-422-3937
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Fax | 315-422-4432
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Provider Business Mailing Address
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Address Line | PO BOX 2003
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4503
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Country | US
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Telephone | 315-446-3904
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Fax | 315-445-2936
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Authorized Official
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Title or Position | OWNER
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Name | THOMAS A BERSANI
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Credential | MD
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Telephone | 315-422-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number |
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License Number State |
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