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NPI Code Detail

MEDICARE: SYRACUSE PLASTIC SURGERY, PLLC

MEDICARE: SYRACUSE PLASTIC SURGERY, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician

General Provider Information

NPI Number : 1134757891
Entity Type Code : Organization
Provider Name (Legal Business Name) : SYRACUSE PLASTIC SURGERY, PLLC
Provider Business Mailing Address
First Line : 3107 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13224-1646
Country : US
Telephone Number : 315-299-5313
Fax Number : 315-299-5661
Provider Business Practice Location Address
First Line : 3107 E GENESEE ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13224-1646
Country : US
Telephone Number : 315-299-5313
Fax Number : 315-299-5661
Authorized Official
Title or Position : MD/ OWNER
Name : DR. DEAN DEROBERTS
Credential : MD
Telephone Number : 315-299-5313
Provider Enumeration Date : 03/30/2020
Last Update Date : 08/15/2024

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1225111917 — DR. ENRIQUE JAVIER ARMENTA MD
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Directions to “SYRACUSE PLASTIC SURGERY, PLLC ” Practice Location

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