Provider Demographics
NPI:1548351935
Name:EYE PLASTIC AND RECONSTRUCTIVE SURGERY OF CNY PC
Entity type:Organization
Organization Name:EYE PLASTIC AND RECONSTRUCTIVE SURGERY OF CNY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-422-3937
Mailing Address - Street 1:PO BOX 2003
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4503
Mailing Address - Country:US
Mailing Address - Phone:315-446-3904
Mailing Address - Fax:315-445-2936
Practice Address - Street 1:3400 VICKERY RD
Practice Address - Street 2:SUITE A
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-4540
Practice Address - Country:US
Practice Address - Phone:315-422-3937
Practice Address - Fax:315-422-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO3985Medicare PIN
820000028Medicare PIN
AA1536Medicare PIN