Healthcare Provider Details

I. General information

NPI: 1174778294
Provider Name (Legal Business Name): CENTRAL NEW YORK SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 GENESEE ST
UTICA NY
13501-4343
US

IV. Provider business mailing address

518 JAMES ST STE 240
SYRACUSE NY
13203-2229
US

V. Phone/Fax

Practice location:
  • Phone: 315-732-1304
  • Fax:
Mailing address:
  • Phone: 315-478-2453
  • Fax: 315-425-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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