Healthcare Provider Details

I. General information

NPI: 1750339412
Provider Name (Legal Business Name): CENTRAL NEW YORK CARDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 GENESEE ST SUITE 200
UTICA NY
13501-5930
US

IV. Provider business mailing address

2211 GENESEE ST SUITE 200
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-733-7598
  • Fax: 315-733-7694
Mailing address:
  • Phone: 315-733-7598
  • Fax: 315-733-7694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN J GAFFNEY
Title or Position: PRESIDENT
Credential: MD
Phone: 315-733-7598