MEDICARE: DEPARTMENT OF MEDICINE MSG

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	332B00000X	Durable Medical Equipment & Medical Supplies		NY
2	207R00000X	Internal Medicine Physician

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	:	1396765632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPARTMENT OF MEDICINE MSG

Provider Business Mailing Address
First Line	:	550 HARRISON ST
Second Line	:	SUITE 200
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3096
Country	:	US
Telephone Number	:	315-464-6527
Fax Number	:	315-464-6529

Provider Business Practice Location Address
First Line	:	550 HARRISON ST
Second Line	:	SUITE 200
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3096
Country	:	US
Telephone Number	:	315-464-6527
Fax Number	:	315-464-6529

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL C. IANNUZZI
Credential	:	MD
Telephone Number	:	315-464-4505

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	10/13/2010

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Directions to “DEPARTMENT OF MEDICINE MSG ” Practice Location

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