Healthcare Provider Details

I. General information

NPI: 1609071059
Provider Name (Legal Business Name): WENDY S VITEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2007
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5792 WIDEWATERS PKWY
SYRACUSE NY
13214-1847
US

IV. Provider business mailing address

5792 WIDEWATERS PKWY
SYRACUSE NY
13214-1847
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-3050
  • Fax: 518-436-9822
Mailing address:
  • Phone: 315-703-3050
  • Fax: 518-436-9822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMT186478
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD12970
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number265221
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: