NPIMap

Organization Active NPI

Aesthetic Plastic Surgery of Syracuse PLLC

  • Plastic and Reconstructive Surgery Physician
  • Camillus, NY
National Provider Identifier
1609865054
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
AESTHETIC PLASTIC SURGERY OF SYRACUSE PLLC
Practice address
5700 W Genesee St
Suite 132
Camillus, NY 13031-3200
Phone
(315) 487-5858
Fax
(315) 487-1950
NPI assigned
Oct 18, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark S PotenzaNPI 1134122096
Title
Owner
Phone
(315) 487-5858

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X NU Primary

Addresses

Primary practice location

5700 W Genesee St
Suite 132
Camillus, NY 13031-3200

Mailing address

PO Box 2003
East Syracuse, NY 13057-4503
Phone (315) 446-3904

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050131000685 NY Part B Supplier - Clinic/Group Practice 7810947413 Receives reassigned benefits from 4 practitioners
Practice locations: Camillus, NY

National Provider Directory

National Provider Directory

Locations

210 Township Blvd
Ste 10
Camillus, NY 13031
Phone (315) 487-5858

5700 W Genesee St
Ste 132
Camillus, NY 13031
Phone (315) 362-2540

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609865054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2003",
            "city": "EAST SYRACUSE",
            "state": "NY",
            "postal_code": "130574503",
            "telephone_number": "315-446-3904",
            "fax_number": "315-445-2936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 W GENESEE ST",
            "address_2": "SUITE 132",
            "city": "CAMILLUS",
            "state": "NY",
            "postal_code": "130313200",
            "telephone_number": "315-487-5858",
            "fax_number": "315-487-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AESTHETIC PLASTIC SURGERY OF SYRACUSE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "POTENZA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "315-487-5858"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camillus, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.