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General NPI Number Information
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NPI Number | 1205929288
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Entity Type | Organization
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Legal Business Name | CNY MEDICAL AND SURGICAL EYE CARE PC
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 5770 COMMONS PARK
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9400
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Country | US
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Telephone | 315-445-1577
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Fax | 315-445-4862
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Provider Business Mailing Address
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Address Line | PO BOX 48
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City | DE WITT
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State | NY
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Zip | 13214-0048
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Country | US
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Telephone | 315-445-1577
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Fax | 315-445-4862
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT WEISENTHAL
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Credential | M.D.
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Telephone | 315-445-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV005571-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 174054-1
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License Number State | NY
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