Provider Demographics
NPI:1619004355
Name:NEW HARTFORD PSYCHIATRIC SERVICES PLLC
Entity Type:Organization
Organization Name:NEW HARTFORD PSYCHIATRIC SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCELLUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:CEPHAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-768-7181
Mailing Address - Street 1:327 ORISKANY BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1422
Mailing Address - Country:US
Mailing Address - Phone:315-768-7181
Mailing Address - Fax:315-768-7182
Practice Address - Street 1:327 ORISKANY BLVD
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1422
Practice Address - Country:US
Practice Address - Phone:315-768-7181
Practice Address - Fax:315-768-7182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207888103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0381Medicare PIN