Organization
NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC
Active
Other names
New York Spine and Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT L. TISO M.D (MD)
(315) 552-6700
Entity
Organization
Contact information
Practice address
5417 WEST GENESEE STREET, SUITE 1, CAMILLUS, NY 13031
(315) 432-4900
(315) 488-2397
Mailing address
PO BOX 510, SYRACUSE, NY 13214-0510
(315) 703-3480
(315) 703-3481
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03423585
—
NY
Enumeration date
05/21/2015
Last updated
05/21/2015
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