1396748448 NPI number — CYNTHIA YOUNGMAYKA P.A.

Table of content: CYNTHIA YOUNGMAYKA P.A. (NPI 1396748448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396748448 NPI number — CYNTHIA YOUNGMAYKA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNGMAYKA
Provider First Name:
CYNTHIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396748448
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8100 OSWEGO RD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
LIVERPOOL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13090-1654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-652-6551
Provider Business Mailing Address Fax Number:
315-652-9698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8100 OSWEGO RD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
LIVERPOOL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13090-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-652-6551
Provider Business Practice Location Address Fax Number:
315-652-9698
Provider Enumeration Date:
05/23/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  0040721 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01270915 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".