Organization Name: | HERITAGE ONE DAY SURGERY LLC |
NPI Number: | 1295002806 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBERT TISO (MD/OWNER) |
Mailing Address: | 5496 E Taft Rd Suite B North Syracuse |
State: | NY US |
Postal Code: | 132123784 |
Phone Number: | 3153622060 |
Fax Number: | |
NPI Enumeration Date: | 11/28/2011 |
NPI Last Update Date: | 05/13/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |