Provider Demographics
NPI:1205929288
Name:CNY MEDICAL AND SURGICAL EYE CARE PC
Entity type:Organization
Organization Name:CNY MEDICAL AND SURGICAL EYE CARE 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 1:5770 COMMONS PARK
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9400
Practice Address - Country:US
Practice Address - Phone:315-445-1577
Practice Address - Fax:315-445-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005571-1152W00000X
NY174054-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG45590Medicare UPIN
NYCC9344Medicare PIN
NYU55823Medicare UPIN
NYRA8922Medicare PIN
NY56716DMedicare PIN
NYRA8221Medicare PIN
NYA03019Medicare UPIN
NY56716BMedicare PIN
NY56716AMedicare PIN
NYB81376Medicare UPIN