Healthcare Provider Details

I. General information

NPI: 1437654555
Provider Name (Legal Business Name): SARAH ANN BALUTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 08/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

725 IRVING AVE 8TH FL
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5420
  • Fax:
Mailing address:
  • Phone: 315-464-7611
  • Fax: 315-464-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number312313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: