Provider Demographics
NPI:1407952260
Name:GYN ONCOLOGY OF CNY, PC
Entity Type:Organization
Organization Name:GYN ONCOLOGY OF CNY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/ PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BUNN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-634-4112
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:5008 BRITTONFIELD PKWY
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9248
Practice Address - Country:US
Practice Address - Phone:315-634-4112
Practice Address - Fax:315-634-4117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCK5968Medicare PIN
NYAA1361Medicare PIN