Healthcare Provider Details

I. General information

NPI: 1669410379
Provider Name (Legal Business Name): SYRACUSE ORTHOPEDIC SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5719 WIDEWATERS PARKWAY
SYRACUSE NY
13214-1880
US

IV. Provider business mailing address

PO BOX 580
SYRACUSE NY
13214-0580
US

V. Phone/Fax

Practice location:
  • Phone: 315-251-3100
  • Fax: 315-552-6018
Mailing address:
  • Phone: 315-251-3100
  • Fax: 315-449-9923

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 Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TODD C BATTAGLIA
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 315-251-3100