Provider Demographics
NPI:1275525578
Name:SYRACUSE, DONALD C (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:C
Last Name:SYRACUSE
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 1:433 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2520
Mailing Address - Country:US
Mailing Address - Phone:973-759-9000
Mailing Address - Fax:973-751-3730
Practice Address - Street 1:1401 BROAD ST
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-4236
Practice Address - Country:US
Practice Address - Phone:973-759-9000
Practice Address - Fax:973-751-3730
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO3894400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC59006Medicare UPIN
NJ483617A3WMedicare PIN