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General NPI Number Information
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NPI Number | 1710523469
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Entity Type | Organization
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Legal Business Name | CYNTHIA M. LAW ADULT HEALTH NP, PLLC
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 161 RIVERSIDE DR
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City | OLD FORGE
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State | NY
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Zip | 13420-7799
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Country | US
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Telephone | 315-369-3693
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Fax | 315-369-0075
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Provider Business Mailing Address
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Address Line | 445 FACTORY ST
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City | WATERTOWN
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State | NY
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Zip | 13601-2729
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Country | US
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Telephone | 315-782-4207
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Fax | 315-782-8699
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | CHARLOTTE SMITH
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Credential |
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Telephone | 315-782-4207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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