Provider Demographics
NPI:1265838916
Name:CAZENOVIA COLLEGE
Entity Type:Organization
Organization Name:CAZENOVIA COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP/DIR HEALTH SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:315-655-7122
Mailing Address - Street 1:22 SULLIVAN ST
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-1054
Mailing Address - Country:US
Mailing Address - Phone:315-655-7122
Mailing Address - Fax:
Practice Address - Street 1:10 SEMINARY ST
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035-1015
Practice Address - Country:US
Practice Address - Phone:315-655-7122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAZENOVIA COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health