Healthcare Provider Details

I. General information

NPI: 1407952260
Provider Name (Legal Business Name): GYN ONCOLOGY OF CNY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY SUITE 400
EAST SYRACUSE NY
13057-9248
US

IV. Provider business mailing address

1001 W FAYETTE ST SUITE 400
SYRACUSE NY
13204-2859
US

V. Phone/Fax

Practice location:
  • Phone: 315-634-4112
  • Fax: 315-634-4117
Mailing address:
  • Phone: 315-472-1488
  • Fax: 315-476-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILEY DOUGLAS BUNN
Title or Position: PHYSICIAN/ PARTNER
Credential: MD
Phone: 315-634-4112