Healthcare Provider Details

I. General information

NPI: 1477503985
Provider Name (Legal Business Name): CAYUGA ANESTHESIA ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 DATES DRIVE
ITHACA NY
14850
US

IV. Provider business mailing address

202 TAUGHANNOCK BLVD PO BOX 366
ITHACA NY
14851
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4011
  • Fax:
Mailing address:
  • Phone: 607-277-3257
  • Fax: 607-277-4056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT MITCHELL
Title or Position: PRESIDENT
Credential: MD
Phone: 607-277-4035