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General NPI Number Information
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NPI Number | 1922215979
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Entity Type | Organization
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Legal Business Name | CNY COSMETIC & RECONSTRUCTIVE SURGERY LLC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 5898 BRIDGE ST
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-2941
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Country | US
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Telephone | 315-663-0112
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Fax | 315-663-0132
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Provider Business Mailing Address
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Address Line | 5898 BRIDGE ST
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City | EAST SYRACUSE
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State | NY
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Zip | 13057
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Country | US
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Telephone | 315-663-0112
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LAURA ALFIERIS
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Credential |
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Telephone | 315-663-0112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 216811-1
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License Number State | NY
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