Provider Demographics
NPI:1134118953
Name:BISWARUP SYAM MD
Entity Type:Organization
Organization Name:BISWARUP SYAM MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BISWARUP
Authorized Official - Middle Name:
Authorized Official - Last Name:SYAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-756-6595
Mailing Address - Street 1:PO BOX 2001
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4501
Mailing Address - Country:US
Mailing Address - Phone:315-449-2208
Mailing Address - Fax:315-362-5120
Practice Address - Street 1:1259 FISHER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1012
Practice Address - Country:US
Practice Address - Phone:607-756-6595
Practice Address - Fax:607-756-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty