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General NPI Number Information
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NPI Number | 1790591576
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Entity Type | Organization
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Legal Business Name | SYRACUSE ASC LLC
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Dates
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Enumeration Date | 12/06/2024
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 225 GREENFIELD PKWY STE 105
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City | LIVERPOOL
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State | NY
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Zip | 13088-6673
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Country | US
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Telephone | 315-451-6911
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2005
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-4505
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Country | US
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Telephone | 315-362-5129
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROWENA ILAG-FERGUSON
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Credential |
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Telephone | 315-451-6911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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