Provider Demographics
NPI:1699829846
Name:CROUSE HEALTH HOSPITAL
Entity Type:Organization
Organization Name:CROUSE HEALTH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TENGERES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-470-2330
Mailing Address - Street 1:736 IRVING AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1687
Mailing Address - Country:US
Mailing Address - Phone:315-470-7317
Mailing Address - Fax:315-470-5845
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-470-7317
Practice Address - Fax:315-470-5845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROUSE HEALTH HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3301008H261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279396Medicaid
NYBA0524Medicare PIN