Provider Demographics
NPI:1023310968
Name:CNY ADVANCED GYNECOLOGY PC
Entity type:Organization
Organization Name:CNY ADVANCED GYNECOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRABHAT
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:AHLUWALIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-823-1111
Mailing Address - Street 1:PO BOX 1023
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13365-1023
Mailing Address - Country:US
Mailing Address - Phone:315-823-1111
Mailing Address - Fax:315-823-1295
Practice Address - Street 1:86 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2389
Practice Address - Country:US
Practice Address - Phone:315-733-3330
Practice Address - Fax:315-823-1295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-29
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty