Healthcare Provider Details

I. General information

NPI: 1821054040
Provider Name (Legal Business Name): NORMAN A LASDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5719 WIDEWATERS PKWY
DE WITT NY
13214-1880
US

IV. Provider business mailing address

5719 WIDEWATERS PKWY
SYRACUSE NY
13214-1880
US

V. Phone/Fax

Practice location:
  • Phone: 315-251-3100
  • Fax: 315-449-9923
Mailing address:
  • Phone: 315-251-3100
  • Fax: 315-449-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number134601
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: