1336145994 NPI number — CAYUGA ORTHOTICS & PROSTHETICS, INC.

Table of content: (NPI 1336145994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336145994 NPI number — CAYUGA ORTHOTICS & PROSTHETICS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAYUGA ORTHOTICS & PROSTHETICS, INC.
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:
1336145994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1583 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14609-7008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-482-4558
Provider Business Mailing Address Fax Number:
585-482-7887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1583 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14609-7008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-482-4558
Provider Business Practice Location Address Fax Number:
585-482-7887
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
RYAN TRENCHARD
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT CERT PROSTHETIST OWNER
Authorized Official Telephone Number:
585-482-4558

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: BK . This is a "EXCELLUS BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PO17005971 . This is a "BLUE CHOICE-EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00446204 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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