MEDICARE: NEW HARTFORD PSYCHIATRIC SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	207888	NY

General Provider Information

NPI Number	:	1619004355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW HARTFORD PSYCHIATRIC SERVICES PLLC

Provider Business Mailing Address
First Line	:	327 ORISKANY BLVD
Second Line	:
City	:	WHITESBORO
State	:	NY
Zip	:	13492-1422
Country	:	US
Telephone Number	:	315-768-7181
Fax Number	:	315-768-7182

Provider Business Practice Location Address
First Line	:	327 ORISKANY BLVD
Second Line	:
City	:	WHITESBORO
State	:	NY
Zip	:	13492-1422
Country	:	US
Telephone Number	:	315-768-7181
Fax Number	:	315-768-7182

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARCELLUS R CEPHAS
Credential	:	MD
Telephone Number	:	315-768-7181

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	05/20/2008

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