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General NPI Number Information
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NPI Number | 1609928217
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Entity Type | Organization
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Legal Business Name | SYRACUSE UNIVERSITY
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 08/06/2013
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Provider Practice Location Address
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Address Line | 621 SKYTOP RD SUITE 1200
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City | SYRACUSE
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State | NY
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Zip | 13244-5290
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Country | US
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Telephone | 315-443-4485
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Fax | 315-443-4413
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Provider Business Mailing Address
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Address Line | 621 SKYTOP RD SUITE 1200
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City | SYRACUSE
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State | NY
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Zip | 13244-5290
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Country | US
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Telephone | 315-443-4485
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Fax | 315-443-4413
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Authorized Official
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Title or Position | DIRECTOR, GEBBIE HEARING CLINIC
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Name | JOSEPH PELLEGRINO
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Credential | AUD
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Telephone | 315-443-2352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | NY
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Legacy Identifiers
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Identifier #1
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Identifier Code | 0T007
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Identifier Type | OTHER
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Identifier State | NY
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Identifier Issuer | BILLING NUMBER - BCBS
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 0T007
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Identifier Type | OTHER
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Identifier State | NY
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Identifier Issuer | BILLING NUMBER - BCBS
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