Provider Demographics
NPI:1336194265
Name:CNY GASTROENTEROLOGY, PLLC
Entity Type:Organization
Organization Name:CNY GASTROENTEROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYEES
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-252-0810
Mailing Address - Street 1:PO BOX 2337
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13220-2337
Mailing Address - Country:US
Mailing Address - Phone:315-422-6705
Mailing Address - Fax:315-422-3909
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-252-0810
Practice Address - Fax:315-252-5179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02974656Medicaid
NYDG7006Medicare PIN
NYAA0442Medicare PIN