Organization
UPSTATE GASTROENTEROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C. IANNUZZI MD (MD)
(315) 464-3835
Entity
Organization
Contact information
Practice address
1000 E GENESEE ST, SUITE 206, SYRACUSE, NY 13210-1892
(315) 464-1616
(315) 464-1617
Mailing address
1000 E GENESEE ST, SUITE 206, SYRACUSE, NY 13210-1892
(315) 464-1616
(315) 464-1617
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
111362
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03747028
—
NY
Enumeration date
08/13/2012
Last updated
03/02/2015
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