Provider Demographics
NPI:1417909656
Name:CENTRAL NEW YORK PHYSIATRY, P.C.
Entity Type:Organization
Organization Name:CENTRAL NEW YORK PHYSIATRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHUL
Authorized Official - Middle Name:JO
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-724-1410
Mailing Address - Street 1:115 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2392
Mailing Address - Country:US
Mailing Address - Phone:315-724-1410
Mailing Address - Fax:315-724-1449
Practice Address - Street 1:115 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2392
Practice Address - Country:US
Practice Address - Phone:315-724-1410
Practice Address - Fax:315-724-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01519213Medicaid
NY55119AMedicare PIN