Provider Demographics
NPI:1144397100
Name:CAYUGA MEDICAL CENTER AT ITHACA
Entity Type:Organization
Organization Name:CAYUGA MEDICAL CENTER AT ITHACA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-274-4443
Mailing Address - Street 1:101 DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1342
Mailing Address - Country:US
Mailing Address - Phone:607-274-4443
Mailing Address - Fax:607-274-4527
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-274-4443
Practice Address - Fax:607-274-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7247020273R00000X
NY7247021273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33S307OtherBLUE CROSS - PSYCH
NY5401001HOtherNYS PROVIDER OPER CERT #
NY365593OtherMVP PROVIDER NO
NY00332729Medicaid
NY365593OtherMVP PROVIDER NO
NY00332729Medicaid
NY33S307OtherBLUE CROSS - PSYCH
NY00332729Medicaid