Provider Demographics
NPI:1578636379
Name:CAYUGA NEUROLOGIC SERVICES LLP
Entity Type:Organization
Organization Name:CAYUGA NEUROLOGIC SERVICES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:STACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-273-6757
Mailing Address - Street 1:119 W BUFFALO ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4131
Mailing Address - Country:US
Mailing Address - Phone:607-273-6757
Mailing Address - Fax:607-273-2854
Practice Address - Street 1:119 W BUFFALO ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4131
Practice Address - Country:US
Practice Address - Phone:607-273-6757
Practice Address - Fax:607-273-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1326112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01335900Medicaid
NY02068793Medicaid
NY00711413Medicaid
NY02883223Medicaid
NY03191393Medicaid
NYF27506Medicare UPIN
NYB82156Medicare UPIN
NYCC0583Medicare ID - Type UnspecifiedJ GAFFNEY
NY02068793Medicaid
NYAA0522Medicare PIN
NYCC0585Medicare ID - Type UnspecifiedS COWDERY
NYCC0584Medicare ID - Type UnspecifiedJ STACKMAN
NY03191393Medicaid