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General NPI Number Information
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NPI Number | 1730596107
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Entity Type | Organization
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Legal Business Name | CAYUGA MEDICAL CENTER EMPLOYED PHYSICIANS GROUP
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/18/2014
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Provider Practice Location Address
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Address Line | 101 DATES DR
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City | ITHACA
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State | NY
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Zip | 14850-1342
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Country | US
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Telephone | 607-274-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 101 DATES DR
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City | ITHACA
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State | NY
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Zip | 14850-1342
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Country | US
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Telephone | 607-274-4441
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JOHN COLLETT
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Credential |
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Telephone | 607-274-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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