Provider Demographics
NPI:1861562829
Name:SYRACUSE ORTHOPEDIC SPECIALISTS, P.C.
Entity type:Organization
Organization Name:SYRACUSE ORTHOPEDIC SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-251-3100
Mailing Address - Street 1:5824 WIDEWATERS PKWY
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-3072
Mailing Address - Country:US
Mailing Address - Phone:315-251-3105
Mailing Address - Fax:315-449-9923
Practice Address - Street 1:4115 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6636
Practice Address - Country:US
Practice Address - Phone:315-329-7600
Practice Address - Fax:315-329-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0618150009Medicare NSC