Healthcare Provider Details

I. General information

NPI: 1578180444
Provider Name (Legal Business Name): CNY FERTILITY COLORADO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 S PARKSIDE DR STE 200
COLORADO SPRINGS CO
80910-3140
US

IV. Provider business mailing address

195 INTREPID LN
SYRACUSE NY
13205-2548
US

V. Phone/Fax

Practice location:
  • Phone: 315-469-8700
  • Fax:
Mailing address:
  • Phone: 315-671-4848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT J KILTZ
Title or Position: MEMBER
Credential: MD
Phone: 315-671-4848