Provider Demographics
NPI:1497753073
Name:CENTRAL NEW YORK INFUSION SERVICES, LLC
Entity Type:Organization
Organization Name:CENTRAL NEW YORK INFUSION SERVICES, LLC
Other - Org Name:CN4 INFUSION SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OPERATING OFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOWKSI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CRNI
Authorized Official - Phone:315-424-7027
Mailing Address - Street 1:220 HERALD PL
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1045
Mailing Address - Country:US
Mailing Address - Phone:315-424-7027
Mailing Address - Fax:315-424-7638
Practice Address - Street 1:220 HERALD PL
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1045
Practice Address - Country:US
Practice Address - Phone:315-424-7027
Practice Address - Fax:315-424-7638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0890L001251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01978647Medicaid
NY1261650001Medicare ID - Type Unspecified