Provider Demographics
NPI:1003262148
Name:FINGER LAKES PHYSIATRY AND INTEGRATIVE HEALTH CARE, PLLC
Entity Type:Organization
Organization Name:FINGER LAKES PHYSIATRY AND INTEGRATIVE HEALTH CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:INZERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DC
Authorized Official - Phone:631-766-0811
Mailing Address - Street 1:821 PRE EMPTION RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2061
Mailing Address - Country:US
Mailing Address - Phone:631-766-0811
Mailing Address - Fax:
Practice Address - Street 1:821 PRE EMPTION RD STE 200
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:631-766-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-08
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7420111N00000X
NY253084208100000X
NY334820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty