Healthcare Provider Details

I. General information

NPI: 1578565719
Provider Name (Legal Business Name): SYRACUSE PROSTHETIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 VICKERY RD STE 4
SYRACUSE NY
13212-4511
US

IV. Provider business mailing address

3300 VICKERY RD STE 4
SYRACUSE NY
13212-4511
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-9697
  • Fax: 315-476-9694
Mailing address:
  • Phone: 315-476-9697
  • Fax: 315-476-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: SHEILA HARRINGTON
Title or Position: ADMINISTRATIVE MGR
Credential:
Phone: 315-476-9697