Provider Demographics
NPI:1225052772
Name:DEPARTMENT OF MEDICINE MEDICAL SERVICE GROUP
Entity Type:Organization
Organization Name:DEPARTMENT OF MEDICINE MEDICAL SERVICE GROUP
Other - Org Name:UNIVERSITY PHYSICIANS INFUSION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:IANNUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-464-3835
Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1892
Mailing Address - Country:US
Mailing Address - Phone:315-464-2929
Mailing Address - Fax:315-464-2930
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:SUITE 403
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1892
Practice Address - Country:US
Practice Address - Phone:315-464-2929
Practice Address - Fax:315-464-2930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207RH0003X, 207RR0500X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1207540011Medicare NSC