Healthcare Provider Details

I. General information

NPI: 1417279084
Provider Name (Legal Business Name): CENTRAL NEW YORK PSYCHIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 02/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9005 OLD RIVER ROAD
MARTINSBURG NY
13404
US

IV. Provider business mailing address

44 HOLLAND AVE
ALBANY NY
12208-3411
US

V. Phone/Fax

Practice location:
  • Phone: 315-765-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROBERT PUCCIO
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 518-473-0795