Provider Demographics
NPI:1942617915
Name:CAYUGA MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CAYUGA MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-277-2365
Mailing Address - Street 1:1301 TRUMANSBURG RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1397
Mailing Address - Country:US
Mailing Address - Phone:607-277-2365
Mailing Address - Fax:607-277-1415
Practice Address - Street 1:8 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1871
Practice Address - Country:US
Practice Address - Phone:607-277-2170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338776364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty