Healthcare Provider Details

I. General information

NPI: 1033290127
Provider Name (Legal Business Name): CYNTHIA JOAN CARLYN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE STRATTON VAMC
ALBANY NY
12208
US

IV. Provider business mailing address

55 PEYSTER ST
ALBANY NY
12208-2529
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6415
  • Fax: 518-626-6564
Mailing address:
  • Phone: 518-591-0518
  • Fax: 518-626-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number225924-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: