Provider Demographics
NPI:1427502327
Name:JAMES M. INZERILLO, MD, PLLC
Entity type:Organization
Organization Name:JAMES M. INZERILLO, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:INZERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-766-0811
Mailing Address - Street 1:821 PRE EMPTION RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2061
Mailing Address - Country:US
Mailing Address - Phone:315-325-4422
Mailing Address - Fax:315-325-4373
Practice Address - Street 1:821 PRE EMPTION RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2061
Practice Address - Country:US
Practice Address - Phone:315-325-4422
Practice Address - Fax:315-325-4373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253084208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty