MEDICARE: SYRACUSE UNIVERSITY

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
1	231H00000X	Audiologist	15000007599	NY

General Provider Information

NPI Number	:	1558339473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYRACUSE UNIVERSITY

Provider Business Mailing Address
First Line	:	621 SKYTOP RD
Second Line	:	SUITE 1200
City	:	SYRACUSE
State	:	NY
Zip	:	13244-5290
Country	:	US
Telephone Number	:	315-443-4485
Fax Number	:	315-443-4413

Provider Business Practice Location Address
First Line	:	621 SKYTOP RD
Second Line	:	SUITE 1200
City	:	SYRACUSE
State	:	NY
Zip	:	13244-5290
Country	:	US
Telephone Number	:	315-443-4485
Fax Number	:	315-443-4413

Authorized Official
Title or Position	:	CLINIC DIRECTOR
Name	:	DR. JOSEPH T PELLEGRINO
Credential	:	AUD
Telephone Number	:	315-443-2352

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	08/06/2013

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Directions to “SYRACUSE UNIVERSITY ” Practice Location

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