Provider Demographics
NPI:1992243687
Name:TED J. TRIANA, DO PC
Entity type:Organization
Organization Name:TED J. TRIANA, DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRIANA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:315-425-1431
Mailing Address - Street 1:6221 STATE ROUTE 31
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8715
Mailing Address - Country:US
Mailing Address - Phone:315-755-0141
Mailing Address - Fax:315-752-0142
Practice Address - Street 1:311 GREEN ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2911
Practice Address - Country:US
Practice Address - Phone:315-425-1431
Practice Address - Fax:315-425-1994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty