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General NPI Number Information
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NPI Number | 1710255120
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Entity Type | Organization
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Legal Business Name | ENDOCRINOLOGY, DIABETES & METABOLISM, PLLC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 399 GRANT AVENUE RD
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City | AUBURN
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State | NY
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Zip | 13021-8202
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Country | US
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Telephone | 315-253-2669
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Fax | 315-282-0077
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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 | 315-701-5607
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Fax | 315-701-5608
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Authorized Official
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Title or Position | OWNER
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Name | SHRIWAN A MIRZA
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Credential | M.D.
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Telephone | 315-253-2669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number |
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License Number State |
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