MEDICARE: KARL R ELSNER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F331645	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073507299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARL R ELSNER NP

Provider Business Mailing Address
First Line	:	PO BOX 2004
Second Line	:
City	:	EAST SYRACUSE
State	:	NY
Zip	:	13057-4504
Country	:	US
Telephone Number	:	315-362-5285
Fax Number	:	315-445-2936

Provider Business Practice Location Address
First Line	:	750 E ADAMS ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2342
Country	:	US
Telephone Number	:	315-464-4363
Fax Number	:	315-464-8690

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	08/31/2012

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