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General NPI Number Information
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NPI Number | 1417622135
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Entity Type | Organization
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Legal Business Name | CENTRAL NEW YORK FAMILY HEALTH NURSE PRACTITIONER PLLC
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 5701 E. CIRCLE DR. #264 SUITE 108
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City | CICERO
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State | NY
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Zip | 13039
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Country | US
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Telephone | 315-876-5748
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Fax |
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Provider Business Mailing Address
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Address Line | 6303 YULEWOOD CIR
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City | CICERO
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State | NY
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Zip | 13039-9251
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Country | US
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Telephone | 315-876-5748
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MIDZY LYSIUS
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Credential | FNP
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Telephone | 315-876-5748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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