Healthcare Provider Details

I. General information

NPI: 1184284580
Provider Name (Legal Business Name): CENTRAL NEW YORK ORTHOPEDICS LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MIDDLE SETTLEMENT RD STE 102
NEW HARTFORD NY
13413-5332
US

IV. Provider business mailing address

4401 MIDDLE SETTLEMENT RD STE 102
NEW HARTFORD NY
13413-5332
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-4496
  • Fax:
Mailing address:
  • Phone: 315-735-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW WICKLINE
Title or Position: MD
Credential:
Phone: 315-735-4496