Basic Information
| Provider Information | |||||||||
| NPI: | 1710179957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SYNERTX | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7241 E NORWOOD ST | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852072050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283805626 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7540 N 19TH AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850217967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8888734221 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2007 | ||||||||
| LastUpdateDate: | 08/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | MAZZITELLO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | FRANK | ||||||||
| AuthorizedOfficialTitleorPosition: | PTA | ||||||||
| AuthorizedOfficialTelephone: | 9283805626 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | AAS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 7492A | AZ | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.