Healthcare Provider Details

I. General information

NPI: 1043656556
Provider Name (Legal Business Name): CENTRAL NEW YORK SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W ONONDAGA ST SUITE 10
SYRACUSE NY
13202-1888
US

IV. Provider business mailing address

518 JAMES ST SUITE 240
SYRACUSE NY
13203-2238
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-2030
  • Fax: 315-478-2250
Mailing address:
  • Phone: 315-478-2453
  • Fax: 315-425-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number8403300A
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN WARREN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 315-478-2453