Healthcare Provider Details

I. General information

NPI: 1154320083
Provider Name (Legal Business Name): FREDERICK SENGSTACKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 PRESIDENTIAL PLZ 3RD FLOOR
SYRACUSE NY
13202-2240
US

IV. Provider business mailing address

90 PRESIDENTIAL PLZ 3RD FLOOR
SYRACUSE NY
13202-2240
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5210
  • Fax: 315-464-2141
Mailing address:
  • Phone: 315-464-5210
  • Fax: 315-464-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number254528
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number254528
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: