# NORTH SHORE MEDICAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487252581
- **Authorized official:** JOSHU COPPOLA PA (PA)
- **Authorized official phone:** (315) 289-6300

## Contact information

- **Practice address:** 311 SKYVIEW TER, SYRACUSE, NY 13219-2835
- **Practice address phone:** (315) 935-1154
- **Practice address fax:** (952) 209-2012
- **Mailing address:** 311 SKYVIEW TER, SYRACUSE, NY 13219-2835
- **Mailing address phone:** (315) 935-1154
- **Mailing address fax:** (952) 209-2012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 10/12/2020
- **Last updated:** 05/16/2022