Healthcare Provider Details

I. General information

NPI: 1770488975
Provider Name (Legal Business Name): EVOLVE ORTHOPEDIC SPECIALIST PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 E TAFT RD
SYRACUSE NY
13212-3291
US

IV. Provider business mailing address

5719 WIDEWATERS PKWY
SYRACUSE NY
13214-1985
US

V. Phone/Fax

Practice location:
  • Phone: 315-418-4155
  • Fax: 315-498-6203
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TODD BATTAGLIA
Title or Position: PRESIDENT
Credential:
Phone: 315-399-8668