Healthcare Provider Details

I. General information

NPI: 1578532875
Provider Name (Legal Business Name): JERRY CAPORASO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 04/08/2025
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 IRVING AVE SUITE 600
SYRACUSE NY
13210
US

IV. Provider business mailing address

725 IRVING AVE SUITE 600
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5162
  • Fax: 315-464-2122
Mailing address:
  • Phone: 315-464-5162
  • Fax: 315-464-2122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2188351
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number218835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: