Healthcare Provider Details

I. General information

NPI: 1326041286
Provider Name (Legal Business Name): LOFTUS, RYU & BARTOL MD'S PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 IRVING AVE STE 108
SYRACUSE NY
13210-1691
US

IV. Provider business mailing address

475 IRVING AVE STE 108
SYRACUSE NY
13210-1691
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-0070
  • Fax: 315-475-0620
Mailing address:
  • Phone: 315-671-0070
  • Fax: 315-475-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0960021
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIE DITOMA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 315-671-0070