Organization
DEPARTMENT OF MEDICINE MSG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL C. IANNUZZI MD (PRESIDENT)
(315) 464-4505
Entity
Organization
Contact information
Practice address
90 PRESIDENTIAL PLZ, SYRACUSE, NY 13202-2240
(315) 464-4505
Mailing address
90 PRESIDENTIAL PLZ, SYRACUSE, NY 13202-2240
(315) 464-4505
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00459903
—
NY
Enumeration date
07/27/2006
Last updated
10/13/2010
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