Provider Demographics
NPI:1093070161
Name:CAYUGA FOOT CARE
Entity Type:Organization
Organization Name:CAYUGA FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FRISK
Authorized Official - Suffix:
Authorized Official - Credentials:DCS
Authorized Official - Phone:607-272-2610
Mailing Address - Street 1:207 N GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4135
Mailing Address - Country:US
Mailing Address - Phone:607-272-2610
Mailing Address - Fax:
Practice Address - Street 1:207 N GENEVA ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4135
Practice Address - Country:US
Practice Address - Phone:607-272-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02916567Medicaid