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General NPI Number Information
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NPI Number | 1740606086
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Entity Type | Organization
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Legal Business Name | CNY MEDICAL AND SURGICAL EYECARE PC
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 5000 BRITTONFIELD PKWY SUITE A-102
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City | EAST SYRACUSE
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State | NY
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Zip | 13057-9226
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Country | US
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Telephone | 315-432-0555
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Fax | 315-463-6219
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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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 008389-1
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License Number State | NY
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