Basic Information
| Provider Information | |||||||||
| NPI: | 1902136096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CORTLAND GASTROENTEROLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2001 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154463904 | ||||||||
| FaxNumber: | 3154452936 | ||||||||
| Practice Location | |||||||||
| Address1: | 1259 FISHER AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077566595 | ||||||||
| FaxNumber: | 6077566594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2010 | ||||||||
| LastUpdateDate: | 01/12/2010 | ||||||||
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| AuthorizedOfficialLastName: | SYAM | ||||||||
| AuthorizedOfficialFirstName: | BISWARUP | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6077566595 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.