Basic Information
| Provider Information | |||||||||
| NPI: | 1134108558 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BATTAGLIA | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | CHRISTOPHER | ||||||||
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| Credential: | MD MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5824 WIDEWATERS PARKWAY | ||||||||
| Address2: | SYRACUSE ORTHOPEDIC SPECIALISTS | ||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152513105 | ||||||||
| FaxNumber: | 3155526018 | ||||||||
| Practice Location | |||||||||
| Address1: | 5179 WIDEWATERS PARKWAY | ||||||||
| Address2: | SYRACUSE ORTHOPEDIC SPECIALISTS | ||||||||
| City: | DEWITT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152513500 | ||||||||
| FaxNumber: | 3154490238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 223417 | MA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 249055 | NY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 249055 | NY | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2106353 | 05 | MA | MEDICAID | 02986143 | 05 | NY | MEDICAID |