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General NPI Number Information
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NPI Number | 1770958100
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Entity Type | Organization
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Legal Business Name | NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 5100 W TAFT RD STE 1B
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City | LIVERPOOL
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State | NY
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Zip | 13088-3808
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Country | US
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Telephone | 315-552-6739
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 510
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City | SYRACUSE
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State | NY
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Zip | 13214-0510
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Country | US
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Telephone | 315-251-3105
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Fax | 315-552-6018
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Authorized Official
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Title or Position | MD/DIRECTOR
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Name | ROBERT TISO
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Credential |
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Telephone | 315-552-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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