Provider Demographics
NPI:1740606086
Name:CNY MEDICAL AND SURGICAL EYECARE PC
Entity Type:Organization
Organization Name:CNY MEDICAL AND SURGICAL EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-445-1577
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214-0048
Mailing Address - Country:US
Mailing Address - Phone:315-445-1577
Mailing Address - Fax:315-445-4862
Practice Address - Street 1:5000 BRITTONFIELD PKWY
Practice Address - Street 2:SUITE A-102
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9226
Practice Address - Country:US
Practice Address - Phone:315-432-0555
Practice Address - Fax:315-463-6219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008389-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01076719Medicaid
NYU55823Medicare UPIN
NY01076719Medicaid
NYRA8922Medicare PIN
NY56716AMedicare PIN
NYA03019Medicare UPIN
NYG45590Medicare UPIN