Healthcare Provider Details

I. General information

NPI: 1376963645
Provider Name (Legal Business Name): SYRACUSE ORTHOPEDIC SPECIALISTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4994 W SENECA TPKE
SYRACUSE NY
13215-2279
US

IV. Provider business mailing address

5824 WIDEWATERS PKWY
EAST SYRACUSE NY
13057-3072
US

V. Phone/Fax

Practice location:
  • Phone: 315-469-5990
  • Fax:
Mailing address:
  • Phone: 315-251-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SETH GREENKY
Title or Position: PRESIDENT
Credential: MD
Phone: 315-251-3100