MEDICARE: CYNTHIA J TREMBLAY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F332650	NY

General Provider Information

NPI Number	:	1750387130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA J TREMBLAY NP

Provider Business Mailing Address
First Line	:	6800 E GENESEE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1089
Country	:	US
Telephone Number	:	315-445-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 E GENESEE ST
Second Line	:
City	:	FAYETTEVILLE
State	:	NY
Zip	:	13066-1089
Country	:	US
Telephone Number	:	315-445-0003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	02/13/2013

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