Provider Demographics
NPI:1225111917
Name:ARMENTA, ENRIQUE JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:JAVIER
Last Name:ARMENTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2298
Mailing Address - Country:US
Mailing Address - Phone:315-476-7459
Mailing Address - Fax:315-471-4036
Practice Address - Street 1:3107 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13224-1646
Practice Address - Country:US
Practice Address - Phone:315-299-5313
Practice Address - Fax:315-299-5661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1307628174400000X
NY130762-1208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY160984946OtherPLASTIC SURGRY
NY160984946Medicare ID - Type UnspecifiedPLASTIC SURGERY
NY160984946Medicare UPIN