Provider Demographics
NPI:1790739407
Name:MICHAEL J GEISS M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL J GEISS M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GEISS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:315-472-5329
Mailing Address - Street 1:2215 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2219
Mailing Address - Country:US
Mailing Address - Phone:315-472-5329
Mailing Address - Fax:315-472-3211
Practice Address - Street 1:2215 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2219
Practice Address - Country:US
Practice Address - Phone:315-472-5329
Practice Address - Fax:315-472-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY55536AMedicare PIN