Provider Demographics
NPI:1912310632
Name:SYRACUSE UNIVERSITY
Entity type:Organization
Organization Name:SYRACUSE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-443-2486
Mailing Address - Street 1:804 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-2340
Mailing Address - Country:US
Mailing Address - Phone:315-443-3595
Mailing Address - Fax:315-443-9461
Practice Address - Street 1:804 UNIVERSITY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-2340
Practice Address - Country:US
Practice Address - Phone:315-443-3595
Practice Address - Fax:315-443-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty