Provider Demographics
NPI:1982771325
Name:CAYUGA MEDICAL CENTER AT ITHACA
Entity Type:Organization
Organization Name:CAYUGA MEDICAL CENTER AT ITHACA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:6072-744-4443
Mailing Address - Street 1:101 DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1342
Mailing Address - Country:US
Mailing Address - Phone:607-274-4443
Mailing Address - Fax:607-274-4527
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-274-4443
Practice Address - Fax:607-274-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011438301OtherUNIVERA PROVIDER NO
NY365593OtherMVP PROVIDER NO
NY00332729Medicaid
NY5401001HOtherNYS PROVIDER OPER CERT NO
NY5401001HOtherNYS PROVIDER OPER CERT NO
NY365593OtherMVP PROVIDER NO
NY00332729Medicaid
NY33U307Medicare Oscar/Certification