MEDICARE: SYRACUSE MEDICAL LLC

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1891270609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYRACUSE MEDICAL LLC

Provider Business Mailing Address
First Line	:	5 FRANKLIN AVE STE 103
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-3521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 FRANKLIN AVE STE 103
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-3521
Country	:	US
Telephone Number	:	973-751-7752
Fax Number	:

Authorized Official
Title or Position	:	MD - OWNER
Name	:	WAYNE CAPUTO
Credential	:	MD
Telephone Number	:	973-751-7752

Provider Enumeration Date	:	09/27/2018
Last Update Date	:	09/27/2018

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