1700952660 NPI number — CAYUGA EMERGENCY PHYSICIANS, LLP

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 1700952660 NPI number — CAYUGA EMERGENCY PHYSICIANS, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAYUGA EMERGENCY PHYSICIANS, LLP
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:
1700952660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
75 REMIT DRIVE
Provider Second Line Business Mailing Address:
SUITE 1248
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60675-1248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-701-3381
Provider Business Mailing Address Fax Number:
239-939-1682

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 DATES DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-1383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-274-4011
Provider Business Practice Location Address Fax Number:
607-274-4527
Provider Enumeration Date:
11/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
M
Authorized Official Title or Position:
LLP MANAGING PARTNER
Authorized Official Telephone Number:
800-253-5358

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03012562 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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