Healthcare Provider Details

I. General information

NPI: 1912941212
Provider Name (Legal Business Name): SYRACUSE ENT SURGEONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3906 E GENESEE STREET
DEWITT NY
13214-1934
US

IV. Provider business mailing address

3906 E GENESEE STREET
DEWITT NY
13214-1934
US

V. Phone/Fax

Practice location:
  • Phone: 315-251-1093
  • Fax: 315-251-1093
Mailing address:
  • Phone: 315-251-1093
  • Fax: 315-251-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICK J CHILES
Title or Position: PRESIDENT
Credential: MD
Phone: 315-251-1093