Provider Demographics
NPI:1467461376
Name:MARC P PIETROPAOLI MD PC
Entity Type:Organization
Organization Name:MARC P PIETROPAOLI MD PC
Other - Org Name:VICTORY SPORTS MEDICINE & ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:SWARTWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-685-7544
Mailing Address - Street 1:791 W GENESEE STREET RD
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-9377
Mailing Address - Country:US
Mailing Address - Phone:315-685-7544
Mailing Address - Fax:315-685-7549
Practice Address - Street 1:791 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9377
Practice Address - Country:US
Practice Address - Phone:315-685-7544
Practice Address - Fax:315-685-7549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206556207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1248090001Medicare NSC
NYG61017Medicare UPIN