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General NPI Number Information
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NPI Number | 1578747192
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Entity Type | Organization
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Legal Business Name | CNY CHILD NEUROLOGY ASSOCIATES
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/18/2007
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Provider Practice Location Address
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Address Line | 5850 HERITAGE LANDING DR
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9359
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Country | US
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Telephone | 315-446-2985
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Fax |
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Provider Business Mailing Address
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Address Line | 5850 HERITAGE LANDING DR
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9359
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Country | US
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Telephone | 315-446-2985
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NANCY J HAVERNICK
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Credential | M.D.
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Telephone | 315-446-2985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 159000
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License Number State | NY
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