Healthcare Provider Details

I. General information

NPI: 1073587416
Provider Name (Legal Business Name): SYRACUSE ENDOSCOPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 CAMPUSWOOD DRIVE SUITE 100
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

5000 CAMPUSWOOD DRIVE SUITE 100
EAST SYRACUSE NY
13057
US

V. Phone/Fax

Practice location:
  • Phone: 315-234-6688
  • Fax: 315-234-6689
Mailing address:
  • Phone: 315-234-6688
  • Fax: 315-234-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number3301219
License Number StateNY

VIII. Authorized Official

Name: MRS. KATHLEEN M KENDRICK
Title or Position: ADMINISTRATOR
Credential: RN, MBA, MSN
Phone: 315-234-6687