Provider Demographics
NPI:1508898321
Name:CENTRAL NEW YORK SERVICES.INC.
Entity Type:Organization
Organization Name:CENTRAL NEW YORK SERVICES.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:315-478-2453
Mailing Address - Street 1:518 JAMES ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2238
Mailing Address - Country:US
Mailing Address - Phone:315-478-2453
Mailing Address - Fax:315-425-8917
Practice Address - Street 1:375 W ONONDAGA ST
Practice Address - Street 2:SUITE 23
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3280
Practice Address - Country:US
Practice Address - Phone:315-478-0610
Practice Address - Fax:315-478-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071111291261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01437365Medicaid