Provider Demographics
NPI:1669542783
Name:CAYUGA ORTHOPEDIC & SPORTS PT
Entity type:Organization
Organization Name:CAYUGA ORTHOPEDIC & SPORTS PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PENS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-253-3291
Mailing Address - Street 1:37 W GARDEN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2662
Mailing Address - Country:US
Mailing Address - Phone:315-253-3291
Mailing Address - Fax:315-258-8759
Practice Address - Street 1:37 W GARDEN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2662
Practice Address - Country:US
Practice Address - Phone:315-253-3291
Practice Address - Fax:315-258-8759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02241569Medicaid
NYAA0914Medicare ID - Type Unspecified