Healthcare Provider Details

I. General information

NPI: 1831028638
Provider Name (Legal Business Name): ADAM DONALD ARCHIBEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVE
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

800 IRVING AVE
SYRACUSE NY
13210-2716
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03029
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: