Healthcare Provider Details

I. General information

NPI: 1518190602
Provider Name (Legal Business Name): CENTRAL NEW YORK SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number406446
License Number StateNY

VIII. Authorized Official

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