Provider Demographics
NPI:1982600581
Name:CENTRAL NEW YORK MEDICAL PRODUCTS, INC.
Entity Type:Organization
Organization Name:CENTRAL NEW YORK MEDICAL PRODUCTS, INC.
Other - Org Name:CNY MEDICAL PRODUCTS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOMUDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-428-9945
Mailing Address - Street 1:749 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2305
Mailing Address - Country:US
Mailing Address - Phone:315-428-9945
Mailing Address - Fax:315-428-0737
Practice Address - Street 1:749 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2305
Practice Address - Country:US
Practice Address - Phone:315-428-9945
Practice Address - Fax:315-428-0737
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL NEW YORK MEDICAL PRODUCTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-28
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00847512Medicaid
NY00847512Medicaid