Healthcare Provider Details

I. General information

NPI: 1710523469
Provider Name (Legal Business Name): CYNTHIA M. LAW ADULT HEALTH NP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 RIVERSIDE DR
OLD FORGE NY
13420-7799
US

IV. Provider business mailing address

445 FACTORY ST
WATERTOWN NY
13601-2729
US

V. Phone/Fax

Practice location:
  • Phone: 315-369-3693
  • Fax: 315-369-0075
Mailing address:
  • Phone: 315-782-4207
  • Fax: 315-782-8699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE SMITH
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 315-782-4207