Provider Demographics
NPI:1487029815
Name:NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC
Entity Type:Organization
Organization Name:NEW YORK ANESTHESIOLOGY MEDICAL SPECIALTIES, PC
Other - Org Name:NEW YORK SPINE AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TISO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-251-3105
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13214-0510
Mailing Address - Country:US
Mailing Address - Phone:315-251-3105
Mailing Address - Fax:
Practice Address - Street 1:6430 TRANSIT RD STE 300
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1033
Practice Address - Country:US
Practice Address - Phone:315-552-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03423585Medicaid
NYAA0670Medicare PIN