Healthcare Provider Details

I. General information

NPI: 1629231204
Provider Name (Legal Business Name): CYTOLOGY ASSOCIATES OF CNY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 11/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 IRVING AVE 9TH FL - PATHOLOGY
SYRACUSE NY
13210-1687
US

IV. Provider business mailing address

4567 CROSSROADS PARK DR
LIVERPOOL NY
13088-3589
US

V. Phone/Fax

Practice location:
  • Phone: 315-470-7396
  • Fax:
Mailing address:
  • Phone: 315-295-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number236767
License Number StateNY

VIII. Authorized Official

Name: TERIZA SHEHATOU
Title or Position: MEMBER
Credential: MD
Phone: 315-470-7396