Provider Demographics
NPI:1609088871
Name:MEDICAL REGISTRY OF CNY INC
Entity Type:Organization
Organization Name:MEDICAL REGISTRY OF CNY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OFFICE MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:315-468-3239
Mailing Address - Street 1:2105 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1656
Mailing Address - Country:US
Mailing Address - Phone:315-468-3239
Mailing Address - Fax:315-468-2917
Practice Address - Street 1:2105 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-1656
Practice Address - Country:US
Practice Address - Phone:315-468-3239
Practice Address - Fax:315-468-2917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY9294L001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01400691Medicaid