Healthcare Provider Details

I. General information

NPI: 1982484861
Provider Name (Legal Business Name): SYRACUSE GYNECOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 BRITTONFIELD PKWY STE 211A
EAST SYRACUSE NY
13057-9208
US

IV. Provider business mailing address

4939 BRITTONFIELD PKWY STE 211A
EAST SYRACUSE NY
13057-9208
US

V. Phone/Fax

Practice location:
  • Phone: 315-917-0118
  • Fax:
Mailing address:
  • Phone: 315-917-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MONIDEEPA BARUAH
Title or Position: OWNER
Credential: MD
Phone: 315-917-0118