Provider Demographics
NPI:1922215979
Name:CNY COSMETIC & RECONSTRUCTIVE SURGERY LLC
Entity Type:Organization
Organization Name:CNY COSMETIC & RECONSTRUCTIVE SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFIERIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-663-0112
Mailing Address - Street 1:5898 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-663-0112
Mailing Address - Fax:
Practice Address - Street 1:5898 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2941
Practice Address - Country:US
Practice Address - Phone:315-663-0112
Practice Address - Fax:315-663-0132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216811-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG79935Medicare UPIN
H40160Medicare UPIN