Basic Information
| Provider Information | |||||||||
| NPI: | 1225111917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMENTA | ||||||||
| FirstName: | ENRIQUE | ||||||||
| MiddleName: | JAVIER | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2200 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154767459 | ||||||||
| FaxNumber: | 3154714036 | ||||||||
| Practice Location | |||||||||
| Address1: | 3107 E GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132241646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152995313 | ||||||||
| FaxNumber: | 3152995661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1307628 | NY | N | Other Service Providers | Specialist | 208200000X | 130762-1 | NY | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 160984946 | 01 | NY | PLASTIC SURGRY | OTHER |