DR. EDWARD TRACY SALL (NPI# 1710961198) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710961198 |
| Entity Type | Individual |
| Full Name | DR. EDWARD TRACY SALL |
| Credential | MD |
| Practice Address |
4900 Broad Rd Phys Office Bldg North Ste 3-s Syracuse NY 13215-2265 |
| Mailing Address |
5700 W Genesee St Ste 229 Camillus NY 13031-3200 |
| Practice Telephone | 3154925923 |
| Practice Fax Number | 3154925960 |
| Mailing Telephone | 3152349865 |
| Mailing Fax Number | 3152349858 |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2017-02-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0602X |
Otolaryngology Specialization: Otolaryngic Allergy |
181365 | NY | Allopathic & Osteopathic Physicians |
| Street Address |
4900 BROAD RD PHYS OFFICE BLDG NORTH STE 3-S |
| City | SYRACUSE |
| State | NY |
| Zip Code | 13215-2265 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336143221 | David C Canfield | Anesthesiology | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2005-06-08 |
| 1205474335 | Meaghan Porter | Physical Therapist | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2019-12-19 |
| 1982262655 | Ryan Christopher Staib | Nurse Anesthetist, Certified Registered | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2019-05-29 |
| 1164989505 | Jessica Detor | Social Worker | 4900 Broad Rd, Physician Office Building North 3n, Syracuse, NY 13215-2265 | 2019-02-21 |
| 1316402415 | Oleksandr Kaplun | Physician Assistant | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2019-02-04 |
| 1003390204 | Ianna Javier Garcia | Occupational Therapist | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2018-09-24 |
| 1194207241 | Rebekah Schu | Physician Assistant | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2018-09-05 |
| 1669990065 | Katrina E Garrigan | Physician Assistant | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2017-09-06 |
| 1336667948 | Kristy Mcgough | Physician Assistant | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2017-09-04 |
| 1285158402 | Nicholas David Treinin | Pharmacist | 4900 Broad Rd, Syracuse, NY 13215-2265 | 2017-07-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396367785 | Jeffrey Alan Gaulrapp | Registered Nurse | Upstate University Hospital Community General Campus, 4900 Broad Road, Syracuse, NY 13215 | 2020-05-08 |
| 1134752454 | Crystal Elizabeth Hoban | Marriage & Family Therapist | 4922 W. Seneca Turnpike, Syracuse, NY 13215 | 2020-02-14 |
| 1083004907 | Roger G Levine Md | Psychiatric Residential Treatment Facility | 4914 West Seneca Turnpkie, Syracuse, NY 13215 | 2015-01-30 |
| 1558771071 | Edleanna Robinson | Licensed Practical Nurse | 5075 W Seneca Turnpike, Syracuse, NY 13215 | 2014-05-06 |
| 1689013450 | Rhonda Lee Philopena | Emergency Medicine | 4900 Broad Rd 1st Fl, Syracuse, NY 13215 | 2013-06-14 |
| 1962778498 | Marie Anne Stevens | Licensed Practical Nurse | 4057 Seneca Tpk, Van Duyn Home and Hospital, Syracuse, NY 13215 | 2012-03-29 |
| 1033439088 | Anna-marie Simpson | Chiropractor | 4922 W Seneca Tpke, Syracuse, NY 13215 | 2010-06-01 |
| 1992028690 | A John Wylie | Pharmacist | 4840 Sherwood Dr., Syracuse, NY 13215 | 2010-03-09 |
| 1669616512 | Asalim A Thabet | Emergency Medicine | 4900 Braod Rd, 1st Fl, Syracuse, NY 13215 | 2009-04-22 |
| 1992948707 | Jesse Reed Gutnick | Surgery | 4900 Borad Rd, Suite 23 North, Syracuse, NY 13215 | 2009-04-08 |
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| Taxonomy Code | 207YX0602X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngic Allergy |
| An otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881763969 | Richard S Silverman | Otolaryngology | 1619 Genesee St, Utica, NY 13501-4732 | 2006-11-06 |
| 1326595547 | W. Matthew White, Md, Pllc | Otolaryngology | 800a 5th Ave, Suite 202, New York, NY 10065-7215 | 2016-09-06 |
| 1134485824 | Richard Hughes Md Ent PC | Otolaryngology | 383 Bay Rd, Queensbury, NY 12804-1405 | 2012-04-06 |
| 1720262686 | Kevin A. O'connell | Otolaryngology | 400 N Main St, Warsaw, NY 14569-1025 | 2007-12-27 |
| 1699891416 | Dimitry Rabkin, M.d., P.C. | Otolaryngology | 202 Quentin Rd, 1st Floor, Brooklyn, NY 11223-1475 | 2007-03-22 |
| 1093862369 | Norbert J Szymula Md PC | Otolaryngology | 115 Professional Pkwy, Lockport, NY 14094-5369 | 2007-01-05 |
| 1962588194 | Cny Medicine & Allergy PC | Otolaryngology | 7900 Turin Rd, Beeches Professional Campus, Rome, NY 13440-1900 | 2006-10-31 |
| 1457437063 | Barry O. Maisel, Md | Otolaryngology | 414 Maple Ave, Suite 600, Saratoga Springs, NY 12866-5550 | 2006-10-27 |
| 1801971817 | Family Ear Nose and Throat Care PC | Otolaryngology | 5010 State Highway 30, Suite 204, Amsterdam, NY 12010 | 2006-10-26 |
| 1538182761 | William Reisacher | Otolaryngology | 520 E 70th St, St-541, New York, NY 10021-9800 | 2006-07-26 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.