Provider Demographics
NPI:1285059865
Name:SOUTHERN NEW YORK NEUROSURGICAL GROUP
Entity type:Organization
Organization Name:SOUTHERN NEW YORK NEUROSURGICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-729-4942
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 418
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-475-3999
Mailing Address - Fax:315-475-4014
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-475-3999
Practice Address - Fax:315-475-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01376512Medicaid
NY34664AMedicare UPIN