Individual
ROBERTA A ROOT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
321 W ONONDAGA ST, SYRACUSE, NY 13202-3262
(315) 478-2453
(315) 425-8917
Mailing address
321 W ONONDAGA ST, SYRACUSE, NY 13202-3262
(315) 478-2453
(315) 425-8917
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
33972
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33972
—
NY
Enumeration date
06/01/2018
Last updated
06/01/2018
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