1437142346 NPI number — CNY ORTHOPEDIC SPORTS MEDICINE PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437142346 NPI number — CNY ORTHOPEDIC SPORTS MEDICINE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CNY ORTHOPEDIC SPORTS MEDICINE PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1437142346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4567 CROSSROADS PARK DR
Provider Second Line Business Mailing Address:
2ND FL
Provider Business Mailing Address City Name:
LIVERPOOL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13088-3589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-434-9307
Provider Business Mailing Address Fax Number:
315-434-9317

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 E GENESEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-422-9233
Provider Business Practice Location Address Fax Number:
315-422-9234
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CARR
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
315-422-9233

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X , with the licence number:  198155 , 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)





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