Individual
DENISE OCTAVIANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1223 N SALINA ST, SYRACUSE, NY 13208-1519
(315) 703-3263
(315) 425-1994
Mailing address
7999 AUSTRIAN PINE CIR, MANLIUS, NY 13104-9372
(315) 703-3263
(315) 425-1994
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
197696-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01604911
—
NY
Enumeration date
09/21/2005
Last updated
03/05/2008
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