Healthcare Provider Details

I. General information

NPI: 1992243687
Provider Name (Legal Business Name): TED J. TRIANA, DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 GREEN ST
SYRACUSE NY
13203-2911
US

IV. Provider business mailing address

PO BOX 660
BALDWINSVILLE NY
13027-0660
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-1431
  • Fax: 315-425-1994
Mailing address:
  • Phone: 315-425-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TED J TRIANA
Title or Position: PRESIDENT
Credential: DO
Phone: 315-425-1431