Healthcare Provider Details

I. General information

NPI: 1730596131
Provider Name (Legal Business Name): CAYUGA MEDICAL CENTER AT ITHACA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 DATES DR STE 109
ITHACA NY
14850-1345
US

IV. Provider business mailing address

201 DATES DR STE 109
ITHACA NY
14850-1345
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-4385
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number032823
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number032823
License Number StateNY

VIII. Authorized Official

Name: MARTIN STALLONE
Title or Position: CEO/SYSTEM PRESIDENT
Credential:
Phone: 607-274-4189