Provider Demographics
NPI:1467876490
Name:SYRACUSE OTOLARYNGOLOGY PLLC
Entity Type:Organization
Organization Name:SYRACUSE OTOLARYNGOLOGY PLLC
Other - Org Name:SYRACUSE OTOLARYNGOLOGY LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PARUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOYAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-254-2030
Mailing Address - Street 1:101 RICHMOND AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204
Mailing Address - Country:US
Mailing Address - Phone:315-254-2030
Mailing Address - Fax:315-254-2031
Practice Address - Street 1:101 RICHMOND AVE STE 320
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2298
Practice Address - Country:US
Practice Address - Phone:315-254-2030
Practice Address - Fax:315-254-2031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty