Basic Information
| Provider Information | |||||||||
| NPI: | 1851781108 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREATER CNY NEUROLOGY CARE, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4567 CROSSROADS PARK DR | ||||||||
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| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130883589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152952100 | ||||||||
| FaxNumber: | 3154540136 | ||||||||
| Practice Location | |||||||||
| Address1: | 888 E BRIGHTON AVE | ||||||||
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| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132052538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153999123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| AuthorizedOfficialLastName: | EL-ZAMMAR | ||||||||
| AuthorizedOfficialFirstName: | ZIAD | ||||||||
| AuthorizedOfficialMiddleName: | MK | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 3153999123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 258239-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 02922521 | 05 | NY | MEDICAID |