Basic Information
| Provider Information | |||||||||
| NPI: | 1285628321 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VENERUS | ||||||||
| FirstName: | BRYAN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2003 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154463904 | ||||||||
| FaxNumber: | 3154452936 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 BURWELL ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133651725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158235230 | ||||||||
| FaxNumber: | 3158235219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 10/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 229527 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.