Provider Demographics
NPI:1659654101
Name:FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC
Entity Type:Organization
Organization Name:FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC
Other - Org Name:CINCINNATUS HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-753-3797
Mailing Address - Street 1:85 SOUTH WEST STREET
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-0000
Mailing Address - Country:US
Mailing Address - Phone:607-753-3797
Mailing Address - Fax:607-753-6677
Practice Address - Street 1:2805 CINCINNATUS ROAD
Practice Address - Street 2:
Practice Address - City:CINCINNATUS
Practice Address - State:NY
Practice Address - Zip Code:13040-0199
Practice Address - Country:US
Practice Address - Phone:607-863-4126
Practice Address - Fax:607-863-3455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH NETWORK OF CENTRAL NEW YORK, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-21
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY331837OtherMEDICARE PTAN