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General NPI Number Information
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NPI Number | 1720535099
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Entity Type | Organization
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Legal Business Name | I - VIEW PSYCHIATRIC NP BEHAVIORAL THERAPY PC
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Dates
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Enumeration Date | 09/04/2016
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Last Update Date | 09/04/2016
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Provider Practice Location Address
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Address Line | 5640 E TAFT RD 5096
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City | SYRACUSE
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State | NY
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Zip | 13220-9810
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Country | US
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Telephone | 315-552-1949
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Fax |
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Provider Business Mailing Address
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Address Line | 5640 E TAFT RD 5096
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City | SYRACUSE
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State | NY
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Zip | 13220-9810
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. ABRAHAM MASARA
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Credential | N.P
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Telephone | 315-552-1949
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 401836
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License Number State | NY
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