Healthcare Provider Details

I. General information

NPI: 1275603227
Provider Name (Legal Business Name): SYRACUSE ORTHOPEDIC SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4888 W TAFT RD
LIVERPOOL NY
13088-4810
US

IV. Provider business mailing address

5824 WIDEWATERS PKWY
EAST SYRACUSE NY
13057-3072
US

V. Phone/Fax

Practice location:
  • Phone: 315-453-4567
  • Fax: 315-457-7679
Mailing address:
  • Phone: 315-251-3100
  • Fax: 315-449-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SETH GREENKY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 315-251-3100